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When present, the tremor associated with CO poisoning is typical of the postural\/intention type. Here, we report on a rare case of toxic encephalopathy with a dominant\u2010hand Holmes\u2010type tremor, characterized by resting, as well as postural and kinetic\/intentional components, in a previously healthy 53\u2010year\u2010old man exposed to CO while actively engaged in the process of performing a physically demanding skilled labor task. The unique neuropathological and functional changes that give rise to Holmes\u2010type tremor and\u00a0how this relates to the selective vulnerability of the inhibitory indirect pathway of the basal ganglia to glutamatergic excitotoxicity mediated by tissue hypoxia are discussed.<\/jats:p>","DOI":"10.1002\/ajim.23235","type":"journal-article","created":{"date-parts":[[2021,2,22]],"date-time":"2021-02-22T10:21:44Z","timestamp":1613989304000},"page":"435-449","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["A rare case of Holmes tremor in a worker with occupational carbon monoxide poisoning"],"prefix":"10.1002","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8015-0145","authenticated-orcid":false,"given":"Jonathan","family":"Rutchik","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Occupational and Environmental Medicine University of California San Francisco San 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