Objective: The aim of our study was to investigate the characteristics of tremor in patients with cerebellar or brainstem lesions.

Background: The cerebellum and the brainstem, which are functionally interrelated structures, play a key role in the pathogenesis of tremor. Although in the literature there are only scarce data on quantitative parameters of tremor due to cerebellar or brainstem lesion, it is generally accepted that their damage cause a slow, frequently irregular, intentional and/or postural tremor of usually less than 3-4 Hz frequency. While the appearance of tremor is common in cerebellar lesions, tremor syndromes due to brainstem injuries are less frequent.

Methods: 42 patients suffering from stroke or cerebral tumour with cerebellar or brainstem lesions proved by CT or MRI were investigated. 10 patients were excluded because of the presence of concomitant conditions that are known to induce tremor. Tremor was recorded with biaxial accelerometers bilaterally simultaneously in resting, postural and intentional position. Patients were divided into subgroups according to the localisation and duration of their lesion, and the intensity of tremor. The subgroup of patients with normal tremor intensity was statistically compared to healthy controls. Some patients were followed-up for several months in every two weeks.

Results: None of the 32 patients had pathologic tremor at rest. Tremor intensity was increased only in 8 patients. 4 of 7 patients with chronic, 9 of 15 with acute stroke, and 6 of 10 patients with tumour presented pathologic postural or intentional tremor. 4 of 25 patients with unilateral cerebellar lesion had bilateral pathologic tremor. Patients with pathologic tremor and normal tremor intensity had lower central frequency (2-3 Hz) and frequency dispersion, higher harmonic index (0,97), higher proportional power in the 0-3 Hz range (45%) on the affected side(s) than healthy controls. In 2 post-stroke patient tremor became normal after 1 and 2 months. Mesencephalon lesions increased tremor intensity without affecting the frequency.

Conclusions: Cerebellar lesions may cause both intentional and postural tremor. Chronic lesions may also be responsible for pathologic tremors. Cerebellar lesions might induce pathological tremor with normal intensity. Further investigations are needed to clarify the role of the cerebellum and brainstem in tremorgenesis.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/quantitative-analysis-of-tremor-in-patients-with-cerebellar-and-brainstem-lesions/