Background We describe an interesting case of a patient in his early 30s who unfortunately suffered severe mid brain intracranial haemorrhage. He was transferred to the local neuro rehabilitation unit, however soon afterwards began showing various symptoms which were later diagnosed as autonomic storming. Patient subsequently developed worsening whole body tremor mostly affecting the left side in keeping with severe Holmes Tremor. We describe the subsequent management and involvement of neurosurgery for deep brain stimulation and the enormous positive effects this led to patient recovery Methods We performed a retrospective review of the patient notes as well as continuing to follow up his progress after discharge from the rehabilitation unit. We reviewed aspects covering level of independence including use of standardised markers including thin FIM FAM. Results MRI scan performed to the patient's showed degeneration in a particular part of the cerebral correct known as the olivary gland - A rare neurological condition involving the inferior olivary nucleus in the brainstem where degeneration actually causes brain tissue swelling. Despite attempts with a variety of antispasmodic medication, including Botulinum Toxin, there was limited progress made during rehabilitation but following referral to local neurosurgical unit and intervention with deep brain stimulation the patient has shown remarkable improvements Conclusion This case highlights yet another example of how new rehabilitation teams need to work closely with surgical teams in delivering appropriate treatment in a timely fashion so as to expedite and improve patient outcomes. Had the surgery occurred much sooner the ongoing cost to the healthcare system would also have been reduced which is important given the current financial challenges facing the NHS.

Dr. Osman Khan is a healthcare professional affiliated with the National Health Service (NHS), United Kingdom. Based in Southampton, UK, Dr. Khan is dedicated to advancing patient care and contributing to medical research and clinical practice. With experience in the healthcare sector, he actively engages in professional development and knowledge exchange through international scientific conferences. Dr. Khan is committed to fostering collaboration among healthcare professionals and sharing insights that support innovation and excellence in healthcare delivery.