Objective: To describe a rare case of contralateral postural tremors of the upper extremity as the only presenting complaint due to a thalamic solid cystic pilocytic astrocytoma.

Background: Thalamic cysts are a rare cause of movement disorders. Few case reports exist describing this phenomenon, usually caused by either neuroepithelial cysts or ependymal cysts. A solid cystic pilocytic astrocytoma of the thalamus has not been reported to present is this manner with long standing tremors as the only complaint.

Method: A 16 year old girl presented with history of coarse postural tremors of the right upper extremity for the past 15 months. There were no neurological deficits. Imaging revealed a well-defined cystic lesion with enhancing solid nodule in the posterior right thalamus (27.8 x 33 x 29.7 mm) with no surrounding perilesional oedema causing obstruction of posterior third ventricle with upstream hydrocephalus. A ventriculoperitoneal shunt was performed at an outside hospital with no relief in symptoms. She underwent stereotactic aspiration of the cyst along with biopsy of the tumor wall through a twist drill craniostomy.

Results: There was complete resolution of the tremors immediately after cyst aspiration. Patient developed transient hemisensory loss which improved on follow up. Histopathology revealed a pilocytic astrocytoma. There has been no recurrence of the tremor at three months of follow. The patient is being observed clinically and radiologically for any increase in tumor size.

Conclusion: Postural tremors caused due to thalamic cystic pilocytic astrocytoma are rarely seen and may be treated using aspiration of the cyst.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/postural-tremors-due-to-a-cystic-thalamic-low-grade-glioma-treated-by-stereotactic-aspiration/