Tremors Flashcards
Resting tremor characteristics
disappears on movement and exaggerated by movement of the contralateral side –> Parkinson’s
Postural tremor characteristics
present in outstretched limbs, may continue during
action but disappears at rest -> Benign essential tremor
Action tremor characteristics
exaggerated with movement. When more
pronounced at extremes point of movement then called intention
tremor. Cerebellar dysfunction
Benign Essential Tremor affected body parts
- Hands (common)
- Head
- Jaw
- Vocal
Essential Tremor excluison criteria
- Isolated focal tremor (voice, head)
- Orthostatic tremor with a high frequency
- Task and or position specific tremor
- Sudden onset and step-wise deterioration (suspect vascular)
Intention Tremor characteristics
- A sign of Cerebellar Dysfunction usually associated with Ataxia
- Acute onset is usually vascular in older patients.
- Subacute presentation with masses, hydrocephalus, drugs
(anticonvulsants), hypothyroidism and paraneoplastic syndromes. - Chronic Progressive
- Alcoholism (due to thiamine deficiency)
- Anticonvulsant (e.g. Phenytoin)
- Multiple Sclerosis
- Idiopathic Cerebellar atrophy
most common cause cereballa stroke
Define Benign Essential Tremor
Progressive, mainly symmetrical, rhythmic, involuntary oscillation movement disorder of the hands and forearms (69% of patients) that is usually absent at rest and present during posture and intentional movements.
Benign Essential Tremor presentations
- Fine tremor (6-12 Hz)
- Symmetrical
- More prominent with voluntary movement
- Worse when tired, stressed or after caffeine
- Improved by alcohol
- Absent during sleep
Benign Essential Tremor Mx for daily dysfunction / embarrassment
1st: Propranolol (contraindicated in asthma)
2nd: Primidone
Benign Essential Tremor Mx for mild cases
Observation - No Tx is required
