目的:霍姆斯震颤(HT)是一种罕见且使人衰弱的运动障碍,包括静息和动作震颤,它以对治疗的抵抗力而闻名。其最常见的原因包括缺血性或出血性损伤和创伤。机械上,合并的休息和行动性震颤被认为需要多巴胺能黑质纹状体系统和齿状丘脑途径的双重损伤,通常靠近中脑,两条途径会合。这项研究的目的是描述HT作为脑积水病例的表现,并讨论潜在的病理机制。临床表现,和治疗选择。
方法:MEDLINE和WebofScience检索了从数据库开始到2021年8月的HT伴脑积水的病例,这些病例与作者自己独特的治疗反应性HT的病例一起汇编。患者特征,出现体征/症状,潜在的诱发因素,干预措施,并记录患者结果.
结果:确定了9例患者,包括作者的视频病例报告。所有患者都有三室扩张模式,至少有一部分是梗阻性脑积水,4例患者被确定为患有低压性脑积水。Parinaud综合征和运动迟缓是最常见的相关体征。左旋多巴和CSF转移是该人群中HT最常用和最有效的治疗方法。这项审查未注册,也没有获得任何资金。
结论:HT是一种难以治疗的脑积水,了解甚少,可能认识不足,限制了本评论中证据的强度。治疗方案包括脑脊液分流,抗帕金森病特工,抗癫痫药,深部脑刺激,和MR引导的聚焦超声,并针对假设涉及其病理生理学的黑质纹状体和齿状丘脑途径。
Holmes tremor (HT) is a rare and debilitating movement disorder comprising both rest and action tremor, and it is known for its resistance to treatment. Its most common causes include ischemic or hemorrhagic insults and trauma. Mechanistically, the combined rest and action tremor is thought to require a double lesion of both the dopaminergic nigrostriatal system and the dentatorubrothalamic pathways, often near the midbrain where both pathways converge. The aim of this study was to characterize HT as a presenting sign in cases of hydrocephalus and to discuss potential pathomechanisms, clinical presentations, and treatment options.
MEDLINE and Web of Science were searched for cases of HT with hydrocephalus from database inception to August 2021, and these were compiled along with the authors\' own unique case of treatment-responsive HT in a child with low-pressure obstructive hydrocephalus secondary to a tectal tumor. Patient characteristics, presenting signs/symptoms, potential precipitating factors, interventions, and patient outcomes were recorded.
Nine patients were identified including the authors\' video case report. All patients had a triventriculomegaly pattern with at least a component of obstructive hydrocephalus, and 4 patients were identified as having low-pressure hydrocephalus. Parinaud\'s syndrome and bradykinesia were the most commonly associated signs. Levodopa and CSF diversion were the most commonly used and effective treatments for HT in this population. This
review was not registered and did not receive any funding.
HT is a poorly understood and probably underrecognized presentation of hydrocephalus that is difficult to treat, limiting the strength of the evidence in this
review. Treatment options include CSF diversion, antiparkinsonian agents, antiepileptic agents, deep brain stimulation, and MR-guided focused ultrasound, and aim toward the nigrostriatal and dentatorubrothalamic pathways hypothesized to be involved in its pathophysiology.