Lecture 5: Neuro Cases 2 Flashcards
What is a tremor?
- An involuntary, rhythmic, oscillatory movement of a body part
- Most common movement disorder seen in primary care clinics
What are the major classifications of tremors?
- Resting
- Action
- Enhanced physiologic
- Essential
- Parkinsonism
- Cerebellar
- Psychogenic
Describe a resting temor.
- 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 an action tremor.
-
Postural tremor: maintaining a position against gravity
- Ex: arm elevation
-
Isometric tremor: muscle contraction against a rigid stationary objects
- Ex: making a fist
-
Kinetic tremor: associated with voluntary movement and includes intention tremor, which is produced w/ target-directed movement
- Ex: reaching for a pen
Describe an 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 patients have tremors that come and go with anxiety, medication use, caffeine intake or fatigue, they do not need further testing
Describe an essential tremor.
- Most common pathological tremor
- Most common in hands and wrists, can also affect head, LEs and voice
- Usually bilatera
- Can be inherited, tends to progress with age
- •5% of those affected retire early or modify career path
- Caffeine and fatigue exacerbate these tremors, alcohol can help symptoms
What is the most common form of Parkinson’s Disease?
Idiopathic Parkinson’s Disease (PD)
What is the classic “parkinsonian” tremor?
“Pill rolling” tremor
What is a classic symptom of Parkinson’s?
Bradykinesia: 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 with distraction
What would a family history of neurologic disease suggest?
Genetic component
(common in essential tremors)
What would a tremor in an older patient with gradual onset suggest?
Parkinson’s Disease or Essential Tremor
What would a sudden onset tremor most likely indicate?
- Psychogenic tremor
- Related to medication use or toxin exposure
- Brain tumor
