Objective: Tremor may be caused by trauma to the central and peripheral nervous systems. Although brain and nerve injuries are common, post traumatic tremor is rare. We report one such case of post traumatic rubral tremor which is a rare symptomatic movement disorder that occurs typically with damage to cerebellar outflow tracts connecting midbrain and cerebellum.

Background: 34 year old male presented with generalised tremulousness (upper limbs predominant) since twenty days. Tremors started three days after sustaining a fall from stairs under the influence of alcohol. Intially the tremors were in both the upper limbs (right more than left) followed by head and speech tremulousness in next four days. Gradually lower limbs were also involved affecting daily activities. He also complained of bifrontal headache and recurrent vomiting.

Methods: Imaging and relevant laboratory investigations.

Results: Neurological examination showed generalised tremulousness, more in the upper limbs, present at rest and increased with sustained posture and becoming violent on goal directed movement. No other neurological deficit was found. MRI brain showed subacute subdural haematoma in bilateral frontoparietal regions with bilateral transtentorial herniation causing mass effect on the midbrain. Decompression surgery done did not relieve tremors. Tremors responded to levodopa (300 mg), given after the trial of therapeutic doses of propranolol (180 mg) and clonazepam (2 mg) failed. Patient is on regular follow up, well controlled on drugs.

Conclusions: Post traumatic rubral tremor is a rare occurrence with few case reports in literature. Trial with levodopa is recommended when standard treatment fails as rubral tremor is difficult to manage medically.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/post-traumatic-rubral-tremor-a-rare-entity/