Hemi Dystonic Tremor Secondary to Large Intraventricular Tumour in 14-Year-Old Ethiopian Patient: Case Report

Abstract

Dystonic tremor is defined as tremor in a body part affected by dystonia, this involves: tremor in an extremity or body part that is affected by dystonia, focal tremors, usually with irregular amplitudes and variable frequency (mainly less than 7 Hz), and mainly postural or kinetic tremors, usually not seen during complete rest. Hemi body movement disorder are often considered to be non-primary movement disorder and usually attributed to secondary causes, including environmental, vascular, neoplastic, and infectious. We report 14-year-old male patient presented with progressive left hemi body dystonic tremor which started from left upper limb and progress to left lower limb over a period of three years. He had associated global type of headache which worsens during morning period. No family history of same illness, normal prenatal history, no birth trauma. Physical examination revealed dystonia of left upper limb and lower limb (upper limb>lower limb) mixed with rhythmic tremulous movement of mainly left upper limb. Fundus examination revealed pappiledema bilaterally. Normal liver function test, normal abdominal ultrasound and negative HIV serology. No MRI was performed due to financial reason, but brain CT-scan showed calcified; mildly contrast enhanced Intraventricular mass extending from foramen magnum to lateral ventricle, displacing the septum pallidum to right side and bilaterally dilated lateral ventricle, with possible pressure effect on right basal ganglia. Following brain imaging diagnosis of left hemi dystonic tremor secondary to Intraventricular mass was made and patient was started on low dose clonazepam for symptomatic relief and given appointment for neurosurgical evaluation. Even though secondary/symptomatic causes of movement disorder is uncommon, it’s important to think of secondary causes in patient whom present with hemi body movement disorder, like our patient, as some of the underlying causes could be easily treatable and the symptoms could be relieved if managed early.