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Neurological Rehabilitation

Pontine Stroke-Induced Resolution of Contralateral Parkinson’s Tremor: A Case Report

Friday, October 24, 2025
8:00 AM - 9:15 AM MT
Location: Kiosk 5

    Poster Presenter(s)

  • Brandon Amirian, MD

    Resident Physician
    State University of New York (SUNY) Downstate Health Sciences Univ PM&R Program
    Brooklyn, New York

    • Co-Author(s)

  • Panayotis Jusakos, MD

    Resident Physician
    One Brooklyn Health System/Kingsbrook Jewish Medical Center PM&R Program
    Brooklyn, New York

  • Eileen Lu, DO

    Resident Physician
    State University of New York (SUNY) Downstate Health Sciences Univ PM&R Program
    Brooklyn, New York

  • SA

    Sanjeev Agarwal, MD

    Program Director
    SUNY Downstate Health Sciences University
    Brooklyn, New York

Disclosure(s):
Brandon Amirian, MD: No financial relationships to disclose
Panayotis Jusakos, MD: No financial relationships to disclose
Eileen Lu, DO: No financial relationships to disclose
Sanjeev Agarwal, MD: No financial relationships to disclose
Case Diagnosis: Acute left pontine stroke

Case Description or Program Description: A 64-year-old male with a history of hypertension, Parkinson’s disease, and acute alcohol intoxication presented to the emergency department with difficulty ambulating, dysarthria, and right hemiparesis. His vital signs were notable for a blood pressure of 163/88, with other vitals signs found to be normal. Physical exam revealed right upper and lower extremity drifting and a left upper extremity resting tremor. Per patient’s history and chart, the patient previously had bilateral resting tremors of the upper extremities. MRI suspicious for ischemia in the left pons. During rehabilitation, his right hemiparesis improved, but the right tremor did not return.

Setting: The patient was admitted to the neurology service and discharged to acute inpatient rehabilitation at the same academic hospital.

Assessment/Results: Noncontrast head CT noted focus of low attenuation within the left pons. MRI demonstrated a high T2/FLAIR signal in the left pons with corresponding abnormalities, suggesting recent ischemia.

Discussion (relevance): Scientific literature has documented ways tremors can be altered at the brain level. Cases have shown stroke-induced tremor resolution, such as a left thalamic and corona radiata stroke leading to complete right-hand tremor cessation, likely due to cerebello-thalamo-cortical circuit disruption. Another case reported essential tremor resolution after a pontine stroke, attributed to fronto-rubro-spinal pathway interruption.

Conclusions: Here, we present a patient with bilateral Parkinson’s resting tremor who experienced unilateral improvement of the contralateral side following a pontine stroke. Deep brain stimulation of areas like the Globus Pallidus Internus is known to alleviate motor symptoms in Parkinson’s disease. We hypothesize that disruption of the left corticospinal tract at the pons level altered motor circuitry, augmenting tremors and leading to contralateral right-hand tremor resolution. This case adds to the understanding of stroke-induced tremor modulation and highlights the complexity of neural pathways in movement disorders.