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Final Program

Neuromodulation

1503 - Postprocedural edema causing stroke-like symptoms following high-intensity focused ultrasound thalamotomy for essential tremor

Friday, February 20, 2026
5:00 PM - 6:30 PM AST
Case Diagnosis: Postprocedural edema causing stroke-like symptoms following high-intensity focused ultrasound thalamotomy for essential tremor

Case Description: A 75 yo female with severe bilateral essential tremors presented for neurosurgical evaluation after failing therapy and maximum medical management, including propranolol, primidone, and topamax. She underwent MR-guided, high-intensity focused ultrasound (HIFU) thalomotomy of the right VIM nucleus for left tremor. Intraoperative exams and postoperative MRI confirmed the lesion and excluded hemorrhage. Post-operatively, she developed left hemiparesis and dysarthria, with difficulty ambulating and a fall. CT head showed post-procedural edema in the right thalamus, extending to the posterior limb of the internal capsule. She was started on a decadron taper and transferred to rehab at a contact-guard level of assistance, although with significant improvements in her tremor. Rehabilitation followed a stroke progression with focus on improving mobility, gait, and ADLs with medical management of additional comorbidities.  After 10 days, she was discharged with near complete resolution of motor deficits at a modified independent to independent functional status.

Discussions:

 Essential tremor is a common, benign, often genetic, involuntary postural or action tremor and can significantly impair ADLs, work, and quality of life. Traditional treatments include weights, therapy, lifestyle modifications, medications, botox and deep brain stimulation. HIFU offers a less invasive approach with remarkable decrease in tremor as in this case, and is now FDA approved for bilateral treatment. Despite positive results, risks include neurological injury and stroke, highlighting the role for acute rehabilitation in mitigating the short and long term functional outcomes for these patients.

Conclusions: HIFU provides a less invasive alternative for treatment of essential tremor, although serious complications can occur with significant impairments. Rehab physicians should be familiar with the indications, outcomes, risks, and rehabilitation associated with this therapy.