Delayed unilateral post-traumatic tremor: Localization studies using single-proton computed tomographic and magnetic resonance spectroscopy techniques

We present the case of a 46-year-old former U.S. Marine who developed unila teral dystonic tremor responsive to anticholinergic medications 13 years af ter contralateral, combat-induced head trauma. Although conventional neuroi maging techniques showed normal brain anatomy, single-proton computed tomog raphic scans demonstrated hypometabolism ipsilateral to the area of old tra uma. Proton echoplanar spectral imaging demonstrated decreased signal in th is same area on creatine imaging, which normalized on anticholinergic medic ation. Choline imaging on medication showed a signal void in the clinically suspected basal ganglia-thalamus region. We believe that these results ind irectly suggest a trans-synaptic origin of the patient's movement disorder.