Tremors

Question 1

How does a dystonic tremor present

Answer 1

Occurs both at rest and with action and is characterized by associated dystonic posturing and the presence of a null point at which change in the position of the affected limb resolves the tremor.
The null point is the position at which the trajectories of the forces caused by dystonic coactivation of agonist and antagonist muscles neutralize each other, which leads to resolution of the tremor.

Question 2

Cerebellar tremor

Answer 2

characterized by increasing tremor amplitude as the limb approaches the target (terminal intention tremor) and the presence of associated cerebellar symptoms.

Question 3

Parkinsonian rest tremor

Answer 3

Reemergence of tremor after a short delay with outstretched posturing and during ambulation, associated with other parkinsonian signs (rigidity, bradykinesia, gait impairment)

Question 4

Essential tremor

Answer 4

Present in the outstretched arm position and with various actions; commonly (but not universally) associated with a positive family history and an improvement in symptoms with ethanol

Question 5

Rubral tremor

Answer 5

caused by focal injury to cerebellar outflow pathways and is characterized by a coarse tremor that is present at rest but most severe during action. This type of tremor has a prominent proximal component and interferes with various actions, such as feeding, typing, and writing, in a nonselective way. Also, MRIs of the brain reveal a focal causative lesion that is not present in this patient.