Vertebrobasilar dolichoectasia compresses midbrain, worsens Parkinson symptoms, and evokes Holmes tremor: A case report

RATIONALE: Parkinson disease (PD) is characterized by bradykinesia, resting tremor, rigidity, as well as other motor and non-motor symptoms due to damage to dopaminergic neurons in the substantia nigra. Holmes tremor (HT), otherwise, manifests itself as resting, intentional, and postural tremors in the limbs, resulting from lesions in the red nucleus of the midbrain. These 2 distinctive maladies seldom emerge simultaneously. This study delineates a case with both PD and HT occurring after vertebrobasilar dolichoectasia. PATIENT CONCERNS: A 54-year-old male patient experienced a gradual aggregation of static and kinetic postural tremors in the last 2 years. DIAGNOSIS: Brain magnetic resonance imaging revealed vertebrobasilar dolichoectasia compressing the midbrain, whereas intracranial ultrasound confirmed the diagnosis of PD. INTERVENTIONS: The patient received long-term medication with levodopa and benserazide hydrochloride tablets, pramipexole hydrochloride, and trihexyphenidyl. OUTCOMES: The tremor was resolved, and the quality of life was improved substantially. LESSONS: In patients with both PD and HT, the identification of underlying causes and the proper symptomatic treatment are crucial for relieving the symptoms. However, the ultimate approaches would be microvascular decompression, deep-brain stimulation, or stereotactic thalamotomy.