Cough tremor as presenting symptom of intraventricular tumor

A 39-year-old woman presented with right-hand tremor triggered by coughing. Her examination revealed tremor and irregular myoclonus at rest and transient right-hand tremor precipitated by coughing (video at Neurology.org). Brain MRI showed intraventricular tumor and partial foramen of Monro obstruction (figure). Intraventricular tumors in this location can cause sudden intermittent hydrocephalus,[1] and focal thalamic lesions may cause hand tremor.2 We hypothesize that compression of the ventral intermediate nucleus of the thalamus caused by cough-induced hydrocephalus, with dysfunction of cerebello-thalamo-cortical circuit, may be the mechanism for cough-associated tremor of the contralateral hand; this disappeared after surgical removal of the subependymoma. Cough tremor may be associated with intraventricular tumors.