脑血管疾病后Holmes震颤的临床、影像和电生理特点

目的 总结脑血管疾病后Holmes震颤的临床、影像和电生理特点。方法 回顾性分析2015年8月-2019年8月就诊于首都医科大学附属北京天坛医院的4例脑血管疾病所致Holmes震颤患者，对其临床、影像及电生理资料进行分析总结。结果 4例患者中2例由高血压性脑出血引起，另外2例分别由脑动静脉畸形和脑海绵状血管瘤破裂出血引起。Holmes震颤出现于原发病后1～24个月，表现为病灶对侧肢体震颤，以上肢多见。头颅MRI检查显示2例患者病灶仅累及丘脑，2例同时累及丘脑和中脑。震颤分析显示静止、姿势、意向及持物1000 g几种状态下震颤的峰频率均在2.6～3.8 Hz，意向状态震颤半宽功率高于静止状态。主动肌与拮抗肌在静息时以同步收缩为主，姿势、意向和持物时以交替收缩为主。3例接受普拉克索治疗均有不同程度缓解。结论 Holmes震颤多由累及中脑、丘脑部位脑血管疾病引起，表现为2～4 Hz低频震颤，意向状态震颤明显，部分患者多巴胺受体激动剂治疗有效。

Clinical,Imaging and Electrophysiological Characteristics of Holmes Tremor Induced by Cerebrovascular Disease

Objective To summarize the clinical, imaging and electrophysiological characteristics of Holmes
tremor induced by cerebrovascular disease.
Methods Four patients with Holmes tremor at Department of Neurology of Beijing Tian Tan
Hospital and from August 2015 to August 2019 were retrospectively analyzed, to summarize their
clinical, imaging and electrophysiological features.
Results Two of four patients were caused by hypertensive intracerebral hemorrhage and the other
two were caused by hemorrhage of arteriovenous malformation and cerebral cavernous angioma,
respectively. Holmes tremor usually occurred in 1-24 months after the initial insult and commonly
involved contralateral upper limb. Brain MRI found that thalamus was involved solely in two patients,
thalamus and midbrain were involved in the other two patients. Tremor analysis showed that peak
frequency of tremor at rest, posture, intention and holding 1000 g was between 2.6-3.8 Hz. Halfwidth
power of tremor at intention was higher than that at rest. The agonistic and antagonistic muscles
mainly contracted synchronously at rest, while they mainly contracted alternately at posture, intention
and holding 1000 g. Three patients showed remission in different degree after pramipexole treatment.
Conclusions Holmes tremor is mainly caused by cerebrovascular disease with midbrain
and thalamus lesion, with 2-4 Hz low frequency of tremor and obvious tremor at intension.
Dopaminergic agonists may be effective for some patients.