case_images: PMC11276402_01
case_images: EMG of the lower limb muscles before (a), and nine months after treatment introduction with methimazole (b). The traces show PsOT at 6 Hz, exclusively when the patient was asked to keep the standing position (tremor was absent at rest or at Mingazzini II position). Tremor was characterized by alternated activation among the examined pairs of antagonist muscles (TA, tibialis anterior/GM, gastrocnemius medialis; VL, vastus lateralis/BF, biceps femoris). Only recordings from the right leg are shown, since findings from the left leg were similar.
case_images: tohm-14-1-924-g1.jpg
case_images: PMC11276402_01_tohm-14-1-924-g1.jpg
case_images: F1
case_images: After excluding a polyneuropathy or other peripheral nervous system disorder, an EMG recording with concentric needle electrodes found a 6-Hz tremor at the level of both the distal and proximal muscles of the lower limbs, only presenting when the patient was asked to stand up (Figure 1a). Nine months after diagnosis, symptoms were still completely controlled with methimazole and a second EMG assessment showed no tremor in the lower limbs while standing (Figure 1b).
case_images: Qualitative and semiquantitative analysis of [123I]-ioflupane SPECT executed nine months after treatment introduction with methimazole. Values show a mild to moderate hypocaptation in the caudate nucleus, more prominent on the left side, and in the putamen, bilaterally. Captation ratios for left caudatum/occipit 2.70 [3.64+/-0.50] and right caudatum/occipit 2.81 [3.64+/-0.50]; Captation ratios for left putamen/occipit 2.42 [3.02+/-0.56] and right putamen/occipit 2.40 [3.02+/-0.56]. Total striatum/occipit ratio 2.58 [3.23+/-0.50]; putamen/caudatus ratio 0.87 [0.83+/-0.07].
case_images: tohm-14-1-924-g2.jpg
case_images: PMC11276402_01_tohm-14-1-924-g2.jpg
case_images: F2
case_images: This indicated a mild bilateral reduction of the striatal binding, with homogeneous involvement of putamen and caudate nucleus (Figure 2).