ABSTRACT
I. Introduction 307
II. Neoplastic Lesions 308
A. Resting and/or Parkinsonian Tremor 308 B. Intention and Cerebellar Tremor 309
C. Holmes Tremor 310
D. Other Tremor Types 310
III. Infectious Intracranial Lesions 311
IV. Vascular Lesions 312
V. Demyelinating Lesions 317
VI. Iatrogenic Etiologies 318
References 319
I. INTRODUCTION
A tremendous number of reports of brain lesions resulting in tremor have been
described in the literature (1-52). Advances in imaging and other diagnostic
techniques have improved the recognition and reporting of lesions that result
in tremor. As a result of this improved technology, a myriad of diseases and path-
ologies from many intracranial regions have been reported to result in almost
every type of tremor. Although most intracranial lesions still follow the
“general rules” regarding localization, pathophysiology, and corresponding
tremor phenomenology such as basal ganglia lesions resulting in a contralateral
resting 4-7 Hz tremor, cerebellar lesions resulting in a slow ipsilateral intention
tremor, and midbrain lesions resulting in a contralateral resting, postural, and
intention tremor, there have been occasional exceptions to the established
notion of tremor pathophysiology. This should, however, be cautiously inter-
preted. Localization by imaging may be only as good as the technological
modality used. An ipsilateral tremor from a large basal ganglia lesion does not
definitively exclude a small contralateral lesion missed by a computed tomogra-
phy (CT) scan. Magnetic resonance imaging (MRI) may better expose a lesion’s
anatomical devastation. Functional (or “pressure”) effects of the lesions on
contiguous or contralateral areas that more intuitively explain a patient’s
tremor phenomenology may not be fully appreciated. Only recent case reports
have considered the “vascular effects” of intracranial lesions on distant brain
regions through magnetic resonance angiography (MRA). With regard to intra-
cranial infectious and neoplastic lesions, tremor resulting from slow infiltration,
co-infection, edema, distant metastasis, and antibody/paraneoplastic phenomena, may be missed or misinterpreted despite contrast enhancement.
