A case of psychogenic tremor during awake craniotomy

Kazumasa Kujirai, Kotoe Kamata, Toshihiro Uno, Keiko Hamada, Makoto Ozaki

Research output: Contribution to journalArticlepeer-review


A 31-year-old woman with a left frontal and parietal brain tumor underwent awake craniotomy. Propofol/remifentanil general anesthesia was induced. Following craniotomy, anesthetic administrations ceased. The level of consciousness was sufficient and she was not agitated. However, the patient complained of nausea 70 minutes into the awake phase. Considering the adverse effects of antiemetics and the upcoming surgical strategy, we did not give any medications. Nausea disappeared spontaneously while the operation was suspended. When surgical intervention extended to the left caudate nucleus, involuntary movement, classified as a tremor, with 5-6 Hz frequency, abruptly occurred on her left forearm. The patient showed emotional distress. Tremor appeared on her right forearm and subsequently spread to her lower extremities. Intravenous midazolam and fentanyl could not reduce her psychological stress. Since the tremor disturbed microscopic observation, general anesthesia was induced. Consequently, the tremor disappeared and did not recur. Based on the anatomical ground and the medication status, her involuntary movement was diagnosed as psychogenic tremor. Various factors can induce involuntary movements. In fact intraoperative management of nausea and vomiting takes priority during awake craniotomy, but we should be reminded that some antiemetics potentially induce involuntary movement that could be caused by surgery around basal ganglia.

Original languageEnglish
Pages (from-to)86-89
Number of pages4
JournalJapanese Journal of Anesthesiology
Issue number1
Publication statusPublished - 2016 Jan
Externally publishedYes


  • Awake craniotomy
  • Involuntary movement
  • Nausea and vomiting
  • Psychogenic tremor

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine


Dive into the research topics of 'A case of psychogenic tremor during awake craniotomy'. Together they form a unique fingerprint.

Cite this