TREMOR

Ask the Following Questions:

1. When does the tremor occur? Intention tremor, which means that the tremor occurs on movement, would suggest that the patient is suffering from a familial or senile tremor or multiple sclerosis, Wilson's disease, or hereditary familial ataxia. It also may suggest alcoholism. Nothing is more dramatic than the intention tremor of alcohol withdrawal. A tremor occurring at rest would suggest Parkinson's disease or manganese poisoning. A fine tremor of the outstretched hands, which is sometimes described as tension tremor, would suggest hyperthyroidism.
2. The next question to ask is whether there are associated neurologic findings. A tremor with long tract findings, such as hyperactive reflexes or Babinski's sign, would suggest multiple sclerosis, whereas a fairly symmetrical tremor with no long tract signs or other neurologic findings would suggest a familial senile tremor. A tremor with mental deterioration would suggest Wilson's disease.
3. Are there associated systemic findings? If the patient has tachycardia and an enlarged thyroid, one should consider hyperthyroidism. However, simply tachycardia alone might indicate that the patient is very sensitive to caffeine. Kayser-Fleischer ring and enlarged liver would suggest Wilson's disease. An enlarged liver alone would suggest alcoholism.

DIAGNOSTIC WORKUP

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.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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