Tremors seen in midbrain hemorrhage 1. Holmes (Rubral) Tremor — hallmark • Type: Mixed resting postural intention tremor • Frequency: Low (≈ 2–4 Hz) • Distribution: Proximal > distal, often upper limb • Onset: Delayed (weeks to months after hemorrhage) • Mechanism: Damage to red nucleus, dentato-rubral, and nigrostriatal pathways 2. Intention tremor • Due to involvement of cerebellothalamic pathways • Becomes worse as the target is approached 3. Postural tremor • Seen when arms are held against