Tremor

Question 1

What are the differentials for a tremor?

Answer 1

Resting: Parkinsons disease
Flapping: Hepatic failure (encephalopathy), respiratory failure (CO2 retention), renal failure (uraemia)
Intention: Cerebellar lesion
Postural: Benign essential tremor, physiological tremor

Question 2

What are the clinical features of a benign essential tremor?

Answer 2

Symmetrical
Worse with movement
May be accompanied by voice and head tremor (titubation)
Exacerbated by writing –> script becomes irregular and large
Improvement with ETOH

Question 3

How would you manage benign essential tremor?

Answer 3

Beta blockers

Gabapentin if CI

Question 4

What are the causes of a physiological tremor?

Answer 4

Fever
Hyperthyroidism
Anxiety states
Medication-induced (e.g. B2-agonists)

Question 5

What are the features of a physiological tremor?

Answer 5

Non progressive, usually symmetrical and fast

Usually purely postural (abolished on action)

Question 6

How would you manage a physiological tremor?

Answer 6

Treat/remove cause if possible

Beta blockers may be required

Question 7

What are the features of a Parkinsonian tremor?

Answer 7

Unilateral in early disease
Demonstrates synkinesis
Abates with writing- script becomes smaller (micrographia)