Delayed Thalamic Intracranial Hemorrhage in an Essential Tremor Patient following Deep Brain Stimulation

could not tolerate higher doses due to somnolence. The patient had also taken topiramate (50 mg twice daily) and propranolol (40 mg twice daily) in the past for tremor control, but discontinued both medications several years ago due to side effects (paresthesias with topiramate and dizziness with propranolol). Family history included ET in the patient’s mother and brother. Past medical history included hypertension, coronary artery disease, coronary artery 4-vessel bypass graft (CABG) 4 years ago, and hyperlipidemia. The patient’s hypertension had been well controlled for the 6 months before evaluation. He quit smoking 30 years ago, and currently drank 1–2 alcohol drinks per week. His medications at the time of assessment included one aspirin per day (81 mg) prescribed after the CABG, felodipine (Plendil) 2.5 mg once daily, metoprolol (Toprol) 25 mg once daily, iron sulfate 325 mg three times a day, fosinopril (Monopril) 40 mg per week, hydrochlorothiazide (Vaseretic) 12.5 mg once a day, simvastatin (Zocor) 20 mg once daily, melatonin 3 mg once a day at nighttime for sleep, omeprazole (Prilosec) 20 mg twice a day, and primidone (Mysoline) 100 mg twice a day. The patient’s general physical examination, vital signs, and neurological exam Dear Sir, Essential tremor (ET) is a common movement disorder characterized by an action or postural tremor [1] that is often difficult to treat pharmacologically. Patients may not respond to medications, or may experience side effects that limit their use [2] . Deep brain stimulation (DBS) is an effective surgical treatment for ET that is refractory to medical management. The procedure uses high-frequency electrical stimulation from an implanted electrode to modify activity of the ventral intermediate (VIM) nucleus of the thalamus. We report the case of a man with ET and a history of controlled hypertension who developed a delayed thalamic intracerebral hemorrhage (ICH) almost 9 weeks following DBS surgery.