tremors Flashcards
most common tremor causes
Cerebellar Enhanced physiologic Essential Parkinsonian Psychogenic
enhanced physiologic tremor
Postural
Low amplitude
Exacerbating medication
Dx: Glucose level, TSH, LFT, Hx of anxiety, caffeine use
Treatment: reassurance, underlying cause
-may be caused by meds, anxiety
melodopa, levodopa, think…
Parkinson’s
combo, 2x day
cerebellar tremor
Ipsilateral Abnormal finger to nose test Abnormal heel to shin test Imbalance Hypotonia
dx: heel-shin, finger-nose
imaging dx: Head CT or MRI
Treatment: Underlying cause or DBS
Multiple sclerosis, stroke, brainstem tumor (tx underlying cause)
postural tremor
maintained against gravity
kinetic tremor
while reaching towards target, tremor worsens
-isometric/intention is subtype: when holding movement
resting tremor
not against gravity
essential tremor
Postural Symmetric Involves hands, wrists, LE b/l, head, voice Family hx Improves with EtOH
Dx: CBC, TSH, CMP to r/o other cause
Tx: propanolol (not if low HR), primidone
worse w. age, one of most common
parkinsonian tremor
Resting tremor Asymmetric Involves distal extremities (fingers) Decreases with voluntary movement Bradykinesia Postural instability Rigidity
Dx imaging: PET or SPECT to eval dopamine pathways
Treatment: Dopamine agonist (carbadopa, levodopa-reduce severity, don’t cure), anticholinergics
-difficulting signing name, with buttoning shirt
psychogenic tremor
Abrupt onset
Spontaneous remission
No tremor with distraction
Changing tremor type
Diagnostic: history!
Treatment: mental health evaluation
if not tx…
Loss of function Loss of independence Mental health issues Loss of career Higher morbidity *if miss cerebellar tremor-->stroke, etc!*
exacerbating meds
Amiodarone (a fib) Amphetamine (stim) Atorvastatin (cholesterol) Beta adrenergic agonist (nebulizer tx, albuterol) Caffeine Carbamezapine Corticosteroid Cyclosporine (rheum) Epinephrine Fluoxetine Haloperidol Hypoglycemic agent
life-threatening
Wilson disease Hyperthyroid Hypocalcemia (Chovstek's sign) or other severe electrolyte abnormalities Multiple sclerosis Tumors
