Tremor induced by toluene misuse successfully treated by a Vim thalamotomy

A 22 year old man developed a vigorous tremor of 5 Hz in his right hand, af ter a 7 year history of toluene misuse. T2 Weighted MRI depicted marked dec reases in the signal intensity of the basal ganglia, red nucleus, and thala mus on both sides. The stereotactic coagulation of the left nucleus ventroi ntermedius (Vim) of the thalamus abolished the tremors in his right hand. T his patient clearly exhibited the pathological involvement of rubral lesion s in generation of a toluene induced tremor on MRI. Toluene induced tremor is an irreversible symptom which persists even after stopping toluene misus e, therefore in medically intractable cases, it should be positively treate d by a Vim thalamotomy.