Tremor presentations Flashcards
Parkinson’s disease (10) + 3 diagnostic symptoms (starred)
- Bradykinesia*
- Hypokensia
- Unilateral rigidity* (lead pipe/cogwheel)
- Rest tremor*
- Balance problems
- Depression/fatigue
- Sleep disturbance
- Constipation
- Cognitive impairment
- Reduced smell sense
What is bradykinesia? (2)
Slowless in initiation of movement
- Reduction in speed/amplitude of repeated actions e.g finger tapping
Define hypokinesia and give 4 key examples (4)
Poverty of movement
- Reduced facial expression/blinking
- Reduced arm swing
- Micrographia - difficulty with fine movements e.g buttoning clothes
- Slow shuffling gait
What is lead pipe rigidity? (3)
- Constant resistance when limb passively flexed
- Increased tone
- No tremor
What is cogwheel rigidity? (3)
Regular intermittent relaxation of tension when limb flexed
- Increased tone
- Tremor
What are the different types of tremor?
- Rest tremor
- Essential tremor
- Intention tremor
- Postural tremor
What is a rest tremor? (4)
- In relaxed limb fully supported at rest
- Slow
- Improves on
1) Moving
2) Mental concentration
3) Sleeping - Pill rolling (thumb over finger)
What test checks for postural instability?
“Pull test” - falling backwards after sharp pull
Hw do the symptoms of Parkinson’s change for sides of involvement?
Unilateral in early disease, bilateral in late disease
What do drug induced tremors tend to look like?
- Rapid onset
- Bilateral
What drugs can cause drug induced Parkinsonism/tremors? (9)
- Antipsychotics (within 10 weeks, 1st gen more likely) : fluphenazine/triflurophenazine
- Anti-emetics: prochlorperazine/metoclopramdide
- SSRIs (rare)
- Calcium channel blockers (rare)
- Cinnarizine
- Amiodraone
- Lithium
- Sodium valproate
Other types of Parkinson’s causing tremors
- Non Parkinson’s dementia (dementia with Lewey bodies/Alzheimer’s)
- MSA
- Progressive supranuclear palsy
What is an essential tremor? (3)
- Improved by alcohol
- Head nodding
- No bradykinesia
What is a postural tremor? (3)
Occurs when held in fixed position against gravity
- Worse when arms outstretched
- Rapid
Give 5 causes of postural tremor
- Phsyiological (alcohol/drugs/anxiety)
- Hyperthyroidism
- Wilson’s disease (chorea)
- Syphillus
- Cerebovascular
disease e.g repeated strokes - Essential tremor
