Head tremor and stroke

Involuntary movements including hand tremor are uncommon but well recognized clinical manifestations after stroke. However, head tremor following acute stroke has rarely been described in the literature. I describe 4 patients who developed head tremor after acute stroke. They presented with side-to-side or up-and-down 2- to 4-Hz head tremor that was aggravated on sitting or standing and disappeared on sleeping. Imaging studies demonstrated infarcts (patients 1-3) and a hemorrhage (patient 4) each involving the paramedian pontomesencephalic region that may contain the crossing superior cerebellar peduncle. These cases illustrate that head tremor is a rare but distinct manifestation of stroke that primarily involves the paramedian pontomesencephalic area.