PMC7070701_01
Axial FLAIR MRI. Chronic infarcts of the (A) right medial cerebellar peduncle and (B) bilateral thalami.
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Approximately 2.5 months after the onset of tremor, a repeat MRI of the brain was obtained, which revealed stable bilateral thalamic and right medial cerebral peduncle strokes (Figure 1).
DaT Scan (I 123-FP CIT). The Scan Demonstrates Absent Radiotracer Activity in the Right Caudate and Putamen and Reduced Radiotracer Uptake within the Left Putamen, with Relatively Preserved Uptake in the Left Caudate.
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There was also reduced radiotracer uptake within the left putamen, with relatively preserved uptake in the left caudate (Figure 2), suggesting that in addition to the vascular insult contributing to her left-hand tremor, she may also have underlying presynaptic nigrostriatal dopaminergic dysfunction.
The Patient is Evaluated Preoperatively without Levodopa in this Video. She is then evaluated postoperatively with the DBS turned on, then turned off. Note the improvement in the amplitude of the tremor at rest, action, and posture when the DBS is turned on.
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Tightness, a correlate of micrographia, and drawing speed worsened slightly post-DBS, showing that some of the parkinsonian features of this case were not affected (Figures 3 and 4; Table 1).
Axes Analysis: (A) Preoperatively and (B) Postoperatively. Note the reduction in number and range of tremor axes.
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Tightness, a correlate of micrographia, and drawing speed worsened slightly post-DBS, showing that some of the parkinsonian features of this case were not affected (Figures 3 and 4; Table 1).