Evolving resting head tremor in parkinsonism: Clinicopathological study of a case

• Published in: Parkinsonism & related disorders 2021-05, Vol.86, p.1-4
• Main Authors: Rajput, Ali H., Khayyam, Aisha A., Auer, Roland N., Robinson, Christopher A., Rajput, Alex
• Format: Article
• Language: English
• Subjects: Aged; Arm; Brain - pathology; Head; Head tremor; Humans; Male; Parkinson Disease - complications; Parkinson Disease - pathology; Parkinsonism; Progressive supranuclear palsy; Rest; Resting tremor; Supranuclear Palsy, Progressive - complications; Supranuclear Palsy, Progressive - pathology; Tremor - etiology
• ISSN: 1353-8020; 1873-5126
• DOI: 10.1016/j.parkreldis.2021.02.030

Resting limb tremor (RLT) is a well known feature in parkinsonism. There is very little information on resting head tremor (RHT) in parkinsonism, and none in pathologically confirmed cases. The association between RLT and RHT remains uncertain. A Caucasian male developed upper limb tremor and voice changes at age 70. He was first assessed at our clinic at age 72. At age 73 he developed resting head tremor (RHT) which prevented him from falling asleep. His status was documented in longitudinal follow-up at our clinic. He had a total of 14 clinical evaluations and four videos made over 6 years. Autopsy of the brain and spinal cord was performed. The resting head tremor improved on antiparkinsonian drugs and resolved completely after four years. Coincident with RHT remission, the upper limb tremor worsened and interfered with feeding, and his lower limb resting tremor became more pronounced. During his course he developed slow, scanning speech and all the cardinal motor findings of parkinsonism. There was no ophthalmoplegia. Post-mortem neuropathological examination revealed prominent progressive supranuclear palsy (PSP) changes and minor Lewy body pathology. This is the first autopsy confirmed case of parkinsonism with RHT. He had dual pathology. Dissociation between RHT and RLT indicates that the oscillatory brain centers for the two were different in this case. •Resting head tremor during mid-course of parkinsonism.•Dissociation of resting head tremor and resting limb resting tremor.•Head tremor improvement on antiparkinsonian drugs and spontaneous remission.•Co-pathology of progressive supranuclear palsy and Parkinson's disease.•Resting head tremor is part of the clinical spectrum of parkinsonism.