A novel degenerative process of the thalamus, red nucleus and connecting pathways

A 51-year-old man presented with 7 year slowly progressive focal tremor affecting the left hand and arm. Therewere no associated neurological findings and no biochemical or genetic cause could be identified. Magneticresonance imaging (MRI) demonstrated extensive symmetrical abnormality involving the thalamus, red nucleiand associated pathways. This appearance has not, to our knowledge, been previously reported. We discussthe neuroanatomy involved and the possible aetiology for the MRI abnormalities.