Holmes Tremor due to Artery of Percheron Infarct: Clinical Case and Treatment Using Deep Brain Stimulation of the Vim and ZI Targets

  • Sarah A. O'Shea
  • Mitchell Elkind
  • Seth L. Pullman
  • Blair Ford


Background: Holmes tremor (HT) arises from disruption of the cerebellothalamocortical pathways. A lesion can interrupt the projection at any point, resulting in this tremor. We describe a case of HT due to the rare artery of Percheron infarct and its successful treatment using deep brain stimulation.

Case report: A 62-year-old woman with a right medial cerebral peduncle and bilateral thalamic stroke developed HT. Ventral intermediate nucleus (Vim) zona incerta (ZI) deep brain stimulation (DBS) surgery was performed, with improvement in her tremor.

Discussion: Our case supports the theory that the more caudal ZI target in combination with Vim is beneficial in treating poorly DBS-responsive tremors such as HT.

Keywords: Deep brain stimulation, Holmes tremor, tremor, neurostimulation

Citation: O’Shea SA, Elkind M, Pullman SL, Ford B. Holmes tremor due to artery of percheron infarct: Clinical case and treatment using deep brain stimulation of the Vim and ZI targets. Tremor Other Hyperkinet Mov. 2020; 10. doi: 10.7916/tohm.v0.732