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In patients with severe tremor that is resistant to drug therapy, stereotactic coagulation can achieve a satisfactory and lasting reduction of the movement disorders. Very few long-term studies have been conducted following stereotactic operations. From 1964 to 1984, 104 patients with a diagnosis of essential tremor were operated on in the Division of Stereotaxy and Neuronuclear Medicine. After an average follow-up period of 8.6 years, 65 patients were examined. In 80%, the success of the stereotactic operation was still evident. Complete disappearance or substantial reduction of the tremor was determined in 69% and moderate improvement in 11.9% of the patients.

We report nine patients who developed dystonia following head trauma. The most frequent form was hemidystonia only (six patients). One patient presented with hemidystonia plus torticollis, one with bilateral hemidystonia and one with torticollis only. Seven patients sustained a severe head injury, and two had a mild head injury. At the time of injury, six were younger than 10 years, two were adolescents, and the patient with torticollis only was an adult. Except in the patient with torticollis only, the onset of dystonia varied considerably from months to years. All patients with hemidystonia had posthemiplegic dystonia of delayed onset. Seven out of 8 patients with hemidystonia had lesions involving the contralateral caudate or putamen, as demonstrated by CT and MR. The patient with hemidystonia plus torticollis had no lesion to the basal ganglia, but a contralateral pontomesencephalic lesion. Response to medical treatment was generally poor. Functional stereotactic operations were performed in seven patients. A variety of factors may be responsible for the vascular or nonvascular posttraumatic basal ganglia lesions, which may lead to dystonia. The pathophysiology seems to be more complex than thought previously. We believe that dystonia following head injury is not as rare as is assumed. Awareness of its characteristics and optimized diagnostic procedures will lead to wider recognition of this entity.