Deep brain stimulation as an effective treatment option for post–midbrain infarction-related tremor as it presents with Benedikt syndrome

Case report

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Benedikt syndrome is a rare but debilitating constellation of symptoms that manifests from infarction of the red nucleus, cerebral peduncle, oculomotor fascicles, and lower oculomotor nucleus. Clinically, it presents as ipsilateral cranial nerve III palsy, contralateral hemiataxia with intention tremor, contralateral hemiparesis, and hyperactive tendon reflexes. Commonly, the tremor upon purposeful movement proves to be the most debilitating manifestation of the infarction with significant impact on the patient's ability to perform activities of daily living and, therefore, quality of life. The authors report the successful management of this debilitating post–midbrain infarction tremor with the insertion of a deep brain stimulator with targets in the contralateral lenticular fasciculus.

Abbreviations used in this paper: AC = anterior commissure; DBS = deep brain stimulation; PC = posterior commissure; Vim = ventral intermediate; WHIGET = Washington Heights–Inswood Genetic Study of Essential Tremor.

Article Information

Address correspondence to: Douglas Anderson, M.D., Department of Neurological Surgery, Loyola University Medical Center, 2160 S. First Avenue, Maywood, Illinois 60153. email:

© AANS, except where prohibited by US copyright law.



  • View in gallery

    Preoperative MR image revealing a lesion in the medial aspect of the left thalamus extending inferiorly along the left cerebral peduncle into the left medial aspect of the midbrain.

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    Diagram of the brain 4 mm below the AC–PC line illustrating the approximate coordinates of the thalamic fasciculus (arrow).

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    Postoperative CT revealing successful implantation of a DBS unit (on the left side of the brain) that extends to the region of the subthalamic nuclei.


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