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sikandar adwani

@SikandarAdwani • 4,960 subscribers

🧠 Neurologist ( Gold Medalist) | 📺 Host of "Grey Matters" on you tube | Advocate for Brain Health and Awareness 🌟 Inspiring Minds, Empowering Communities

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A 62 year old man comes to OPD with a simple complaint. Doctor, my left hand does not stay still. I watch him quietly before examining him. When his left hand rests on the chair, there is a slow, coarse tremor. When he stretches his arms forward, the tremor continues. When he is asked to touch his nose, the tremor markedly increases as the finger approaches the target. This is not a single tremor. This is rest, postural, and intention tremor together. Then comes the old history that changes everything. Eight months ago, he had a right thalamic hemorrhage. There was weakness initially, which slightly improved. The tremor appeared only months later. That delay is important. This is not Parkinson’s disease, because the tremor does not settle with movement. This is not a pure cerebellar tremor, because it is present even at rest. This pattern fits Holmes tremor. Now the localisation becomes clear. The lesion was in the right thalamus. The thalamus is the final relay for two major motor systems. The cerebellothalamic pathway carries coordination signals from the cerebellum. Its disruption explains why the tremor worsens during target-directed movement. The basal ganglia thalamic motor modulation controls stability at rest. Its disruption explains why the tremor is present even when the hand is relaxed. A single thalamic lesion can disturb both systems at once. Because motor control is contralateral, a right thalamic hemorrhage produces symptoms in the left hand. The tremor appears late because this is not just tissue damage. It reflects delayed maladaptive reorganisation of motor networks. The final diagnosis is left-hand Holmes tremor due to a right thalamic hemorrhage. Permission taken for the vdo #Neurotwitter #Medtwitter #Holmes

A 62 year old man comes to OPD with a simple complaint. Doctor, my left hand does not stay still. I watch him quietly before examining him. When his left hand rests on the chair, there is a slow, coarse tremor. When he stretches his arms forward, the tremor continues. When he is asked to touch his nose, the tremor markedly increases as the finger approaches the target. This is not a single tremor. This is rest, postural, and intention tremor together. Then comes the old history that changes everything. Eight months ago, he had a right thalamic hemorrhage. There was weakness initially, which slightly improved. The tremor appeared only months later. That delay is important. This is not Parkinson’s disease, because the tremor does not settle with movement. This is not a pure cerebellar tremor, because it is present even at rest. This pattern fits Holmes tremor. Now the localisation becomes clear. The lesion was in the right thalamus. The thalamus is the final relay for two major motor systems. The cerebellothalamic pathway carries coordination signals from the cerebellum. Its disruption explains why the tremor worsens during target-directed movement. The basal ganglia thalamic motor modulation controls stability at rest. Its disruption explains why the tremor is present even when the hand is relaxed. A single thalamic lesion can disturb both systems at once. Because motor control is contralateral, a right thalamic hemorrhage produces symptoms in the left hand. The tremor appears late because this is not just tissue damage. It reflects delayed maladaptive reorganisation of motor networks. The final diagnosis is left-hand Holmes tremor due to a right thalamic hemorrhage. Permission taken for the vdo #Neurotwitter #Medtwitter #Holmes

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How to approach tremor in Neuro OPD Consent taken for the video - Diagnosis #Tremor #Neurotwitter #Medtwitter

How to approach tremor in Neuro OPD Consent taken for the video - Diagnosis #Tremor #Neurotwitter #Medtwitter

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