A lesion of the anterior thalamus producing dystonic tremor of the hand

Background: Thalamic tremor is typically characterized by resting and inten tion components; a postural element is often present as well. Previously re ported cases of acquired thalamic tremor have demonstrated lesions in the p osterior thalamus or dentatorubrothalamic tract. Objectives: To report a case of dystonic-postural tremor of the upper extre mity that occurred after a contralateral anterior thalamic infarct, and to discuss potential tremorigenic mechanisms. Design: Case report. Setting: Municipal hospital neurology clinic. Patient: A 65-year-old right-handed woman suddenly developed a dystonic tre mor in her left hand after undergoing coronary bypass surgery. The tremor p ersisted unchanged for 8 months, at which time she was evaluated by us. Cra nial magnetic resonance imaging scans demonstrated a right anterior thalami c infarct. Conclusion: To our knowledge, this is the first report of focal tremor caus ed by a lesion of the anterior thalamus.