Diagnostic Tests for Benign Fasciculation Syndrome
Benign Fasciculation Syndrome Tests: Book Excerpts
Benign Fasciculation Syndrome Diagnosis: Book Excerpts
Diagnostic Tests for Benign Fasciculation Syndrome: Online Medical Books
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TREMOR:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
Certainly a thyroid profile should be done on all cases that present with a tremor alone. In addition, blood tests for serum copper and ceruloplasmin should be done when Wilson's disease is suspected. A drug and alcohol screen should be done also. If multiple sclerosis, Wilson's disease, or a cerebellar tumor is suspected, a CT scan or MRI of the brain should be done. When there is doubt as to whether the tremor is a resting or active tremor, an EMG may be done to separate the two. Most patients presenting with a mild intention tremor that is symmetrical and not associated with other neurologic findings will probably have familial or senile tremor, and the response to beta-blockers can be determined.
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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Tremors:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Begin the patient history by asking the patient about the tremor’s onset (sudden or gradual) and about its duration, progression, and any aggravating or alleviating factors. Does the tremor interfere with the patient’s normal activities? Does he have other symptoms? Ask the patient and his family and friends about behavioral changes or memory loss.
Explore the patient’s personal and family medical history for a neurologic (especially seizures), endocrine, or metabolic disorder. Obtain a complete drug history, noting especially the use of phenothiazines. Also, ask about alcohol use.
Assess the patient’s overall appearance and demeanor, noting mental status. Test range of motion and strength in all major muscle groups while observing for chorea, athetosis, dystonia, and other involuntary movements. Check deep tendon reflexes and, if possible, observe the patient’s gait.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Fasciculations:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
If the patient isn’t in severe distress, find out if he has experienced sensory changes, such as paresthesia, or any difficulty speaking, swallowing, breathing, or controlling bowel or bladder function. Ask him if he’s in pain.
Explore the patient’s medical history for neurologic disorders, cancer, and recent infections. Also, ask him about his lifestyle, especially stress at home, on the job, or at school.
Ask the patient about his dietary habits and for a recall of his food and fluid intake in the recent past because electrolyte imbalances may also cause muscle twitching.
Perform a physical examination, looking for fasciculations while the affected muscle is at rest. Observe and test for motor and sensory abnormalities, particularly muscle atrophy and weakness, and decreased deep tendon reflexes. If you note these signs and symptoms, suspect motor neuron disease, and perform a comprehensive neurologic examination.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Tremors:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Begin the patient history by asking the patient about the tremor’s onset (sudden or gradual) and about its duration, progression, and any aggravating or alleviating factors. Does the tremor interfere with the patient’s normal activities? Does he have other symptoms? Has he noticed any behavioral changes or memory loss? (The patient’s family or friends may provide more accurate information on this.)
Explore the patient’s personal and family medical history for a neurologic (especially seizures), endocrine, or metabolic disorder. Obtain a complete drug history, noting especially the use of phenothiazines. Also, ask about alcohol use.
Assess the patient’s overall appearance and demeanor, noting mental status. Test range of motion and strength in all major muscle groups while observing for chorea, athetosis, dystonia, and other involuntary movements. Check deep tendon reflexes and, if possible, observe the patient’s gait.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Fasciculations:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
If the patient isn’t in severe distress, find out if he has experienced any sensory changes, such as paresthesia, or any difficulty speaking, swallowing, breathing, or controlling bowel or bladder function. Ask him if he’s in pain.
Explore the patient’s medical history for neurologic disorders, cancer, and recent infections. Also, ask him about his lifestyle, especially stress at home, on the job, or at school.
Ask the patient about his dietary habits and for a recall of his food and fluid intake in the recent past because electrolyte imbalances may also cause muscle twitching.
Perform a physical examination, looking for fasciculations while the affected muscle is at rest. Observe and test for motor and sensory abnormalities, particularly muscle atrophy and weakness, and decreased deep tendon reflexes. If you note these signs and symptoms, suspect motor neuron disease, and perform a comprehensive neurologic examination.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Tremor:
Physical examination.
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
A general search for signs of central nervous system involvement, drug use or withdrawal, and peripheral neuropathy may uncover secondary tremor causes. A focused examination of affected body parts, including provocative tests, may distinguish among the tremor types. Essential tremor is usually bilateral, symmetric, and increases with observed provocative testing such as maintaining a posture against gravity, pouring water, or drawing. It most commonly involves the hands and arms. It can also involve the head and voice. In advanced stages, leg and feet involvement can occur.
Parkinsonian tremor, the classic “pill rolling” resting tremor, remits with movement. It can herald the onset of Parkinson’s disease, or develop concurrently with rigidity, bradykinesia, and postural instability. Psychogenic tremors appear and remit suddenly, can exhibit unusual combinations of rest and intention tremors, occur in the presence of other unrelated neurologic signs, and diminish with distraction.
Testing.
The diagnosis and classification of tremor is usually made without laboratory testing or imaging studies, although drug- and disease-specific testing may identify secondary causes. In some cases, electromyographic studies can help distinguish among tremor types; indirectly measure functional disability; and, by repeated testing, assess the progression of the tremor. Clinical functional disability scales may also assess tremor progression. Pharmacotherapeutic challenges (dopaminergic agents in suspected PD and beta-blockers or primidone in suspected essential tremor) may provide further diagnostic insight.
Diagnostic assessment.
In most cases, the diagnosis of tremor is based on specific historical and physical examination findings. Proper treatment depends on classification of the tremor type and the identification of secondary causes. When the cause or classification of tremor is unclear, observation of tremor progression over time may uncover its cause, and guide patient and provider expectations of severity and dysfunction.
References
1. Deuschl G, Bain P, Brin M, et al. Consensus statement of the Movement Disorder Society on Tremor. Mov Disord 1998;13(Suppl 3):2–23.
2. Charles PD, Esper GJ, Davis TL, Maciunas RJ, Robertson D. Classification of tremor and update on treatment. Am Fam Physician 1999;59:1565–1572.
3. Koller WC, Busenbark K, Miner K, et al. The relationship of essential tremor to other movement disorders: report on 678 patients. Ann Neurol 1994;35:717–722.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Tremor/InvoluntaryMovements:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
A postural tremor is characterized by fine regular movement of the fingers or hands with the arms outstretched. It is not present at complete rest. Anxiety, benign essential tremor, hyperthyroidism, or medications (alcohol, caffeine, lithium, beta agonists, or phenytoin) may cause it. Proximal postural tremors involving the shoulder, pelvis, and neck are due to cerebellar lesions.
An intention or action tremor, characterized by irregular jerking brought out by movement, can be caused by cerebellar disorders such as multiple sclerosis and alcoholic or paraneoplastic cerebellar degeneration (lung or ovarian cancer). Hereditary ataxias also follow this pattern.
A rest tremor is evident with the affected part supported and at rest and dampened during voluntary activity, fluctuating in amplitude. It is activated during walking, and interferes with use of eating utensils and with writing. It occurs with Parkinson disease, phenothiazines, severe essential tremor, Wilson disease, mercury poisoning, general paresis, and with midbrain lesions (stroke or demyelinating disease).
Choreiform movements are brief, irregular, jerky, nonrhythmic muscle contractions. Ballismus is a large amplitude jerk that produces flinging of the limb. It is commonly unilateral (hemiballismus). Athetosis is a continuous, sinuous, writhing movement of the digits, limbs, trunk, face, or tongue. Dystonia is a slow, involuntary twisting spasm. Tics are patterned coordinated movements that appear suddenly and intermittently.
Writing or drawing may demonstrate the large, tremulous, angulated loops of essential tremor or the micrographia of Parkinsonism. Horizontal or vertical head tremor is associated with essential tremor, cervical dystonia, or midline cerebellar syndromes, while face, lip, and jaw tremors are seen in Parkinsonism.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Tremors:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Assess the patient’s overall appearance and demeanor, noting mental status. Test range of motion and strength in all major muscle groups while observing for chorea, athetosis, dystonia, and other involuntary movements. Check deep tendon reflexes and, if possible, observe the patient’s gait.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Tremors:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Begin the patient history by asking the patient about the tremor's onset (sudden or gradual) and about its duration, progression, and any aggravating or alleviating factors. Does the tremor interfere with the patient's normal activities? Does he have other symptoms? Ask the patient and his family and friends about behavioral changes or memory loss.
Explore the patient's personal and family medical history for a neurologic (especially seizures), endocrine, or metabolic disorder. Obtain a complete drug history, noting especially the use of phenothiazines. Also, ask about alcohol use.
Assess the patient's overall appearance and demeanor, noting mental status. Test range of motion and strength in all major muscle groups while observing for chorea, athetosis, dystonia, and other involuntary movements. Check deep tendon reflexes and, if possible, observe the patient's gait.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Asterixis [Liver flap, flapping tremor]:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
To elicit asterixis, have the patient extend his arms, dorsiflex his wrists, and spread his fingers (or do this for him if necessary). Briefly observe him for asterixis. Alternatively, if the patient has a decreased level of consciousness (LOC) but can follow verbal commands, ask him to squeeze two of your fingers. Consider rapid clutching and unclutching indications of asterixis, or elevate the patient's leg off the bed and dorsiflex the foot. Briefly check for asterixis in the ankle. If the patient can tightly close his eyes and mouth, watch for irregular tremulous movements of the eyelids and corners of the mouth. If he can stick out his tongue, observe the patient for continuous quivering. (See Recognizing asterixis.)
Action stat!
Because asterixis may signal serious metabolic deterioration, quickly evaluate the patient's neurologic status and vital signs. Compare this data with baseline measurements, and watch carefully for acute changes. Continue to closely monitor his neurologic status, vital signs, and urine output.
If the patient has hepatic disease, assess him for early indications of hemorrhage, including restlessness, tachypnea, and cool, moist, pale skin. If the patient is jaundiced, check for pallor in the conjunctiva and mucous membranes of the mouth.
It's important to recognize that hypotension, oliguria, hematemesis, and melena are late signs of hemorrhage. Prepare to insert a large-bore I.V. catheter for fluid and blood replacement. Position the patient flat in bed with his legs elevated 20 degrees. Begin or continue to administer oxygen.
If the patient has renal disease, briefly review the therapy he has received. If he's on dialysis, ask about the frequency of treatments to help gauge the severity of disease. Question a family member if the patient's LOC is significantly decreased.
Then assess the patient for hyperkalemia and metabolic acidosis. Look for tachycardia, nausea, diarrhea, abdominal cramps, muscle weakness, hyperreflexia, and Kussmaul's respirations. Prepare to administer sodium bicarbonate, calcium gluconate, dextrose, insulin, or sodium polystyrene sulfonate.
If the patient has pulmonary disease, check for labored respirations, tachypnea, accessory muscle use, and cyanosis, which are critical signs. Prepare to provide oxygen via nasal cannula, mask, or intubation and mechanical ventilation.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Fasciculations:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If the patient isn't in severe distress, find out if he has experienced sensory changes, such as paresthesia, or any difficulty speaking, swallowing, breathing, or controlling bowel or bladder function. Ask him if he's in pain.
Explore the patient's medical history for neurologic disorders, cancer, and recent infections. Also, ask him about his lifestyle, especially stress at home, on the job, or at school.
Ask the patient about his dietary habits and for a recall of his food and fluid intake in the recent past because electrolyte imbalances may also cause muscle twitching.
Perform a physical examination, looking for fasciculations while the affected muscle is at rest. Observe and test for motor and sensory abnormalities, particularly muscle atrophy and weakness, and decreased deep tendon reflexes. If you note these signs and symptoms, suspect motor neuron disease, and perform a comprehensive neurologic examination.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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Diagnosis of Benign Fasciculation Syndrome
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