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Flashcards in tremors Deck (13):
1

most common tremor causes

Cerebellar
Enhanced physiologic
Essential
Parkinsonian
Psychogenic

2

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

3

melodopa, levodopa, think...

Parkinson's
combo, 2x day

4

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)

5

postural tremor

maintained against gravity

6

kinetic tremor

while reaching towards target, tremor worsens
-isometric/intention is subtype: when holding movement

7

resting tremor

not against gravity

8

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

9

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

10

psychogenic tremor

Abrupt onset
Spontaneous remission
No tremor with distraction
Changing tremor type

Diagnostic: history!
Treatment: mental health evaluation

11

if not tx...

Loss of function
Loss of independence
Mental health issues
Loss of career
Higher morbidity
*if miss cerebellar tremor-->stroke, etc!*

12

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

13

life-threatening

Wilson disease
Hyperthyroid
Hypocalcemia (Chovstek's sign) or other severe electrolyte abnormalities
Multiple sclerosis
Tumors