Tremors Flashcards
A 56 year old woman has tremor of both hands for 12 months, worse with holding objects, eg a knife and fork. Her father had Parkinsons disease. She has hypothyroidism and drinks 10 units of alcohol per week. The tremor is not alcohol responsive.
What is the most likely diagnosis?
Essential tremor
What is an essential tremor?
Essential tremor is a nervous system (neurological) disorder that causes involuntary and rhythmic shaking.
It can affect almost any part of your body, but the trembling occurs most often in the hands in action and NOT at rest
What are the signs of an essential tremor?
Begin gradually, usually more prominently on one side of the body
Worsen with movement
Usually occur in the hands first, affecting one hand or both hands
May be aggravated by emotional stress, fatigue, caffeine or temperature extremes
How would you distinguish an essential tremor from Parkinson’s disease?
Essential tremor of the hands usually occurs when you use your hands. Tremors from Parkinson’s disease are most prominent when your hands are at your sides or resting in your lap
Essential tremor doesn’t cause other health problems, but Parkinson’s disease is associated with stooped posture, slow movement and shuffling gait
Essential tremor mainly involves your hands, head and voice. Parkinson’s disease tremors usually start in your hands, and can affect your legs, chin and other parts of your body.
What causes essential tremor?
About half of essential tremor cases appear to result from a genetic mutation (autosomal dominant)
Age (40 +)
How would you manage an essential tremor?
Mild symptoms: no treatment
Severe symptoms: beta-blockers (propranolol), Anti-seizure medications (primidone)
What is a physiological tremor?
Tremor seen in people when the muscles are activated
The tremor is typically postural and is thought to arise from the resonant oscillation of a limb as a result of mechanical factors affecting it.
Does NOT interfere with daily living
What is the frequency for a essential tremor?
5-12 Hz
What is a cerebellar tremor?
A tremor that mainly affects the head and upper half of the body, which is absent at rest
Terminal tremor
What are key features about a Parkinsonian tremor?
Occurs at REST and is less prominent with voluntary movements
Occurs in distal upper extremity and is often unilateral
Not familial
What can improve Parkinsonian tremors?
Levodopa, anticholinergics
What is a tremor?
A tremor is an involuntary, somewhat rhythmic, muscle contraction and relaxation involving oscillations or twitching movements of one or more body parts
What is a cerebellar tremor?
A slow, broad tremor of the extremities that occurs at the end of a purposeful movement, such as trying to press a button or touching a finger to the tip of one’s nose
Cerebellar tremor is caused by lesions in or damage to the cerebellum resulting from stroke, tumor, or disease such as multiple sclerosis or some inherited degenerative disorder
