(4) Neuro Cases 2 Flashcards
What is a tremor?
“An involuntary, rhythmic, oscillatory movement of a body part and is the most common movement disorder seen in primary care clinics.”
What are the (7) major classifications of tremors?
- Resting
- Action
- Enhanced physiologic
- Essential
- Parkinsonism
- Cerebellar
- Psychogenic
Describe a:
Resting Tremor
Occurs in body part that is relaxed and completely supported against gravity
Enhanced by mental stress or movement of another body part
DIMINISHED by voluntary movement of that body part
Describe a:
Action Tremor
(describe the three subtypes)
Postural tremor : maintaining a position against gravity (i.e. arm elevation)
Isometric tremor : muscle contraction against a rigid stationary objects (i.e. making a fist)
Kinetic tremor : associated with voluntary movement and includes intention tremor, which is produced w/ target-directed movement (i.e. reaching for a pen)
Describe a:
Enhanced physiologic tremor
EVERYBODY has an asymptomatic physiologic tremor
(low amplitude, high frequency at rest and during activity)
Enhanced by anxiety, stress and certain medications
***If pt.s have tremors that come and go with anxiety, med use, caffeine intake or fatigue, they don’t need further testing
What is the most common pathological tremor?
Essential tremor
What are some telltale signs that your patient has an essential tremor?
Caffine and fatigue make worse
ALCOHOL can lessen symptoms
Common in hands/wrists
What is the mechanism of parkinsons?
Low dopamine
What is the most common form of parkinsons?
Idiopathic Parkinson’s Disease (PD)
What is the classic “parkinsonian” tremor?
“Pill rolling” tremor
What is a classic symptom of parkinsons?
Bardykinesia
(Difficulty rising from a seated position, micrographia, reduced arm swing while walking)
Describe a:
Cerebellar tremor
Low-frequency, slow-intention or postural tremor
Caused by MS with cerebellar plaques, stroke or brainstem tumors
What is particularly challenging about diagnosing a psychogenic tremor?
It can be VERY difficult to differentiate from organic tremor
What are some telltale signs of a psychogenic tremor?
Abrupt onset
Spontaneous remission
Changing tremor characteristics
Increase with attention and extinction w/ distraction
CLINICAL PEARLS
What would a family hx of neurologic disease suggest?
Genetic component
COMMON IN ESSENTIAL TREMORS
Writing sample:
Most likely PD or Essential tremor?
PD:
Small, can be illegible
Writing sample:
Most likely PD or Essential tremor?
Essential tremor
Large, tremulous, can be illegible
