Neuro Cases 2 Flashcards
What is a tremor?
Involuntary, rhythmic, oscillatory movement of a body part and is the most common movement disorder seen in primary care practices
What are the various classficiations of tremors?
Resting Tremors
Action Tremors
Enhanced Physiologic Tremor
Essential Tremor
Parkinsonism Tremor
Cerebellar Tremor
Psychogenic Tremor
What is 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 (walking)
Diminished by voluntary movement of that body part
What is an action tremor?
Occur with Voluntary Muscle Contraction
- MOST TREMORS are action tremors
3 subtypes
- Postural Tremor
- Isometric Tremor
- Kinetic Tremor
What is a Postural Tremor?
A type of Action Tremor
Maintaining position against gravity (i.e. arm elevation)
What is an Isometric Tremor?
A type of Action Tremor
Muscle contraction against a rigid stationary object (i.e. making a fist)
What is a Kinetic Tremor?
A type of Action Tremor
Associated with voluntary movement and includes Intention Tremor
Intention tremor is produced with target-directed movement (i.e. reaching for a pen)
What is an Enhanced Physiologic Tremor?
Everybody has an asymptomatic [hysiologic tremor
Low amplitude, high frequency at rest and during activity
Enhanced by anxiety, stress, certain medications and metabolic conditions
If patients have tremors that come and go with anxiety, med use, caffeine intake or fatigue, they dont need further testing
What is an Essential Tremor?
Most common PATHOLOGICAL tremor
95% of pts have primarily kinetic rather than postural
Most common in hands and wrists, can also affect head, LEs and voice
Usually bilateral, is present with different tasks and interferes with activities
Can be inherited, tends to progress with age
25% of those affected retire early or modify career path, can cause social embarrassment
Caffeine and Fatigue make it worse
Alcohol makes it better
What is Parkinsonism Tremor?
Clinical Syndrome characterized by:
- Various meds cause Parkinsonism by blocking or depleting dopamine
- Most common form is idiopathic Parkinson’s disease (PD), a chronic neurodegenerative disease with a prevalence of 1%
70% of pts with PD have a resting tremor as their presenting feature, can get better with action
Classic tremor starts as a pill-rolling motion of the fingers
Bradykinesia (slow movement) includes difficulty rising from a seated position, reduced arm swing while walking, micrographia
What is a cerebellar tremor?
Classic: Low-frequency, slow-intension or postural tremor, and it typically caused by multiple sclerosis with cerebellar plaques, stroke, or brainstem tumors
What is a Psychogenic Tremor?
Can be difficult to differentiate from organic tremor
Some features that are consistent include abrupt onset, spontaneous remission, changing tremor characteristics (including location and frequency), increase with attention and extinction with distraction.
More frequently seen in patients employed in allied health professions, those involved in litigation
What are signs/histroy consistent with PD?
Tremor, Subtle decrease in dexterity
Decreased arm swing on the first invovled side
Soft voice
Sleep disturbances
Decreased sense of smell
Symptoms of autonomic dysfunction (e.g., constipation, sweating abnormalities, sexual dysfunction, seborrheic dermatitis)
Subtle decrease in dexterity
decreased facial expression
A general feeling of weakness, malaise, or lassitude
Depression or anhedonia
Slowness in thinking
How does the handwriting of a person with PD differ from handwriting of a person with Essential Tremor?
PD Handwriting is small and can be illegible
Essential Tremor handwriting is Large, tremulous, and can be illegible
What are the Features of a Parikinsonism Tremor?
At rest, increases with walking, decreases with posture holding or action
Frequency is 3-6 Hz
Asymmetrical
Hands and Legs
Handwriting is small
Course is progressive
Family history is less common (1%)
Bradykinesia, rigidity, loss of postural reflexes
Treated with Anticholinergics
Or can have a Deep Brain Stimulation implant inserted to help reduce tremors
