Delayed‐Onset Unilateral Upper Limb Tremors Caused by Cortical Superficial Siderosis due to Hemorrhagic Infarction on the Contralateral Motor Cortex

ABSTRACT

This case report described a 75‐year‐old man with delayed‐onset upper limb tremors after cerebral hemorrhagic infarction. Fourteen months prior, the patient had undergone multiple cerebral infarctions, including in the right motor cortex, after percutaneous coronary intervention for acute myocardial infarction. Although the neurological deficits recovered completely afterwards, the patient manifested postural and action tremors of 8 Hz in the left upper limb 10 months later. Brain magnetic resonance imaging revealed cortical superficial siderosis due to chronic hemorrhagic infarction in the right motor cortex with a linear hypointense lesion on the T2*‐weighted images. Cerebral cortical infarcts can cause tremors due to damage to the neural loop between the motor cortex and the basal ganglia. Profound damage on the normal neural networks caused by hemorrhagic transformation of infarcts might result in delayed reorganization of the aberrant neural networks leading to the delayed onset of tremors.