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Diseases » Tremor » Causes
 

Causes of Tremor

Contents
  1. Tremor: Introduction
  2. List of Causes
  3. Drugs/substances (721 causes)
  4. Drug interaction (249 causes)
  5. Hidden causes
  6. Excerpts from book chapters
  7. Causes of symptoms
  8. News
  9. Related cause information

List of causes of Tremor

Following is a list of causes or underlying conditions (see also Misdiagnosis of underlying causes of Tremor) that could possibly cause Tremor includes:

More causes: see full list of causes for Tremor

Causes of Tremor (Diseases Database):

The follow list shows some of the possible medical causes of Tremor that are listed by the Diseases Database:

Source: Diseases Database

Tremor Causes: Book Excerpts

Tremor as a symptom:

Conditions listing Tremor as a symptom may also be potential underlying causes of Tremor. Our database lists the following as having Tremor as a symptom of that condition:

Medications or substances causing Tremor:

The following drugs, medications, substances or toxins are some of the possible causes of Tremor as a symptom. This list is incomplete and various other drugs or substances may cause your symptoms. Always advise your doctor of any medications or treatments you are using, including prescription, over-the-counter, supplements, herbal or alternative treatments.

See full list of 721 medications causing Tremor


Drug interactions causing Tremor:

When combined, certain drugs, medications, substances or toxins may react causing Tremor as a symptom.

The list below is incomplete and various other drugs or substances may cause your symptoms. Always advise your doctor of any medications or treatments you are using, including prescription, over-the-counter, supplements, herbal or alternative treatments.

  • Methyldopa and lithium interaction
  • Aldomet and lithium interaction
  • Amodopa and lithium interaction
  • Labetalol and tricyclic antidepressant interaction
  • Normodyne and tricyclic antidepressant interaction
  • more interactions...»

See full list of 249 drug interactions causing Tremor

Medical news summaries relating to Tremor:

The following medical news items are relevant to causes of Tremor:

Related information on causes of Tremor:

As with all medical conditions, there may be many causal factors. Further relevant information on causes of Tremor may be found in:

Causes of Tremor: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the causes of Tremor.

Tremor: Differential Diagnosis
(In a Page: Signs and Symptoms)

Resting tremors

  • Parkinson's disease
    –“Pill-rolling” appearance
    –Associated cog-wheel rigidity, shuffling gait, akinesis, and/or depression
  • Benign familial or essential tremor
    –Especially common with head tremor (e.g., actress Katherine Hepburn)
    –Positive family history
    –No other neurologic findings
  • Drug or toxin-induced tremors (e.g., MPTP)
  • Postural tremors: Elicited when a limb is held up against gravity; caused by metabolic conditions (e.g., thyrotoxicosis)
  • Voluntary movement (hyperkinetic) tremors
  • Wilson's disease
  • Stroke
  • Cerebellar disease
    Movement tremors
  • Intentional tremor: Occurs with movement toward a target; associated with a cerebellar deficit which would inhibit (e.g., multiple sclerosis, midbrain injury or stroke)

    • » READ BOOK EXCERPT ONLINE »

    Source: In a Page: Signs and Symptoms, 2004

    Tremors: Medical causes
    (Handbook of Signs & Symptoms (Third Edition))

    Alcohol withdrawal syndrome

    Acute alcohol withdrawal after long-term dependence may first be manifested by resting and intention tremors that appear as soon as 7 hours after the last drink and progressively worsen. Other early signs and symptoms include diaphoresis, tachycardia, elevated blood pressure, anxiety, restlessness, irritability, insomnia, headache, nausea, and vomiting. Severe withdrawal may produce profound tremors, agitation, confusion, hallucinations and, possibly, seizures.

    Alkalosis

    Severe alkalosis may produce a severe intention tremor along with twitching, carpopedal spasms, agitation, diaphoresis, and hyperventilation. The patient may complain of dizziness, tinnitus, palpitations, and peripheral and circumoral paresthesia.

    Benign familial essential tremor

    Benign familial essential tremor, a tremor of early adulthood, produces a bilateral essential tremor that typically begins in the fingers and hands and may spread to the head, jaw, lips, and tongue. Laryngeal involvement may result in a quavering voice.

    Cerebellar tumor

    An intention tremor is a cardinal sign of cerebellar tumor; related findings may include ataxia, nystagmus, incoordination, muscle weakness and atrophy, and hypoactive or absent deep tendon reflexes.

    Graves’ disease

    Fine tremors of the hand, nervousness, weight loss, fatigue, palpitations, dyspnea, and increased heat intolerance are some of the typical signs of Graves’disease. It’s also characterized by an enlarged thyroid (goiter) and exophthalmos.

    Hypercapnia

    Elevated partial pressure of carbon dioxide may result in a rapid, fine intention tremor. Other common findings include headache, fatigue, blurred vision, weakness, lethargy, and decreasing level of consciousness (LOC).

    Hypoglycemia

    Acute hypoglycemia may produce a rapid, fine intention tremor accompanied by confusion, weakness, tachycardia, diaphoresis, and cold, clammy skin. Early patient complaints typically include mild generalized headache, profound hunger, nervousness, and blurred or double vision. The tremor may disappear as hypoglycemia worsens and hypotonia and decreased LOC become evident.

    Multiple sclerosis (MS)

    An intention tremor that waxes and wanes may be an early sign of MS. Commonly, visual and sensory impairments are the earliest findings. Associated effects vary greatly and may include nystagmus, muscle weakness, paralysis, spasticity, hyperreflexia, ataxic gait, dysphagia, and dysarthria. Constipation, urinary frequency and urgency, incontinence, impotence, and emotional lability may also occur.

    Parkinson’s disease

    Tremors, a classic early sign of Parkinson’s disease, usually begin in the fingers and may eventually affect the foot, eyelids, jaw, lips, and tongue. The slow, regular, rhythmic resting tremor takes the form of flexion-extension or abduction-adduction of the fingers or hand, or pronation-supination of the hand. Flexion-extension of the fingers combined with abduction-adduction of the thumb yields the characteristic pill-rolling tremor.

    Leg involvement produces flexion-extension foot movement. Lightly closing the eyelids causes them to flutter. The jaw may move up and down, and the lips may purse. The tongue, when protruded, may move in and out of the mouth in tempo with tremors elsewhere in the body. The rate of the tremor holds constant over time, but its amplitude varies.

    Other characteristic findings include cogwheel or lead-pipe rigidity, bradykinesia, propulsive gait with forward-leaning posture, monotone voice, masklike facies, drooling, dysphagia, dysarthria, and occasionally oculogyric crisis (eyes fix upward, with involuntary tonic movements) or blepharospasm (eyelids close completely).

    Thalamic syndrome

    Central midbrain syndromes are heralded by contralateral ataxic tremors and other abnormal movements, along with Weber’s syndrome (oculomotor palsy with contralateral hemiplegia), paralysis of vertical gaze, and stupor or coma.

    Anteromedial-inferior thalamic syndrome produces varying combinations of tremor, deep sensory loss, and hemiataxia. However, the main effect of this syndrome may be an extrapyramidal dysfunction, such as hemiballismus or hemichoreoathetosis.

    Thyrotoxicosis

    Neuromuscular effects of thyrotoxicosis include a rapid, fine intention tremor of the hands and tongue, along with clonus, hyperreflexia, and Babinski’s reflex. Other common signs and symptoms include tachycardia, cardiac arrhythmias, palpitations, anxiety, dyspnea, diaphoresis, heat intolerance, weight loss despite increased appetite, diarrhea, an enlarged thyroid and, possibly, exophthalmos.

    Wernicke’s disease

    An intention tremor is an early sign of Wernicke’s disease — a thiamine deficiency. Other features include ocular abnormalities (such as gaze paralysis and nystagmus), ataxia, apathy, and confusion. Orthostatic hypotension and tachycardia may also develop.

    West Nile encephalitis

    This brain infection is caused by West Nile virus, a mosquito-borne flavivirus endemic to Africa, the Middle East, western Asia, and the United States. Mild infections are common and include fever, headache, and body aches, commonly accompanied by rash and swollen lymph glands. More severe infections are marked by headache, high fever, neck stiffness, stupor, disorientation, coma, tremors, occasional seizures, paralysis and, rarely, death.

    Other causes

    Drugs

    Phenothiazines (particularly piperazine derivatives such as fluphenazine) and other antipsychotics may cause resting and pill-rolling tremors. Infrequently, metoclopramide and metyrosine also cause these tremors. Lithium toxicity, sympathomimetics (such as terbutaline and pseudoephedrine), amphetamines, and phenytoin can all cause tremors that disappear with dose reduction.

    » READ BOOK EXCERPT ONLINE »

    Source: Handbook of Signs & Symptoms (Third Edition), 2006

    Asterixis [Liver flap, flapping tremor]: Medical causes
    (Handbook of Signs & Symptoms (Third Edition))

    ❑ Hepatic encephalopathy. A life-threatening disorder, hepatic encephalopathy initially causes mild personality changes and a slight tremor. The tremor progresses into asterixis — a hallmark of hepatic encephalopathy — and is accompanied by lethargy, aberrant behavior, and apraxia. Eventually, the patient becomes stuporous and displays hyperventilation. When he slips into a coma, hyperactive reflexes, a positive Babinski’s sign, and fetor hepaticus are characteristic signs. The patient may also experience bradycardia, decreased respirations, and seizures.

    ❑ Severe respiratory insufficiency. Characterized by life-threatening respiratory acidosis, severe respiratory insufficiency initially produces headache, restlessness, confusion, apprehension, and decreased reflexes. Eventually, the patient becomes somnolent and may demonstrate asterixis before slipping into a coma. Associated signs and symptoms of respiratory insufficiency include difficulty breathing and rapid, shallow respirations. The patient may be hypertensive in early disease but hypotensive later.

    ❑ Uremic syndrome. A life-threatening disorder, uremic syndrome initially causes lethargy, somnolence, confusion, disorientation, behavior changes, and irritability. Eventually, signs and symptoms appear in diverse body systems. Asterixis is accompanied by stupor, paresthesia, muscle twitching, fasciculations, and footdrop. Other signs and symptoms include polyuria and nocturia followed by oliguria and, then, anuria; elevated blood pressure; signs of heart failure and pericarditis; deep, gasping respirations (Kussmaul’s respirations); anorexia; nausea; vomiting; diarrhea; GI bleeding; weight loss; ammonia breath odor; and metallic taste (dysgeusia).

    Other causes

    ❑ Drugs. Certain drugs, such as the anticonvulsant phenytoin, may cause asterixis.

    » READ BOOK EXCERPT ONLINE »

    Source: Handbook of Signs & Symptoms (Third Edition), 2006

    Tremors: Medical causes
    (Professional Guide to Signs & Symptoms (Fifth Edition))

    Alcohol withdrawal syndrome

    Acute alcohol withdrawal after long-term dependence may first be manifested by resting and intention tremors that appear as soon as 7 hours after the last drink and progressively worsen. Other early signs and symptoms include diaphoresis, tachycardia, elevated blood pressure, anxiety, restlessness, irritability, insomnia, headache, nausea, and vomiting. Severe withdrawal may produce profound tremors, agitation, confusion, hallucinations, and seizures.

    Alkalosis

    Severe alkalosis may produce a severe intention tremor along with twitching, carpopedal spasms, agitation, diaphoresis, and hyperventilation. The patient may complain of dizziness, tinnitus, palpitations, and peripheral and circumoral paresthesia.

    Benign familial essential tremor

    This disorder of early adulthood produces a bilateral essential tremor that typically begins in the fingers and hands and may spread to the head, jaw, lips, and tongue. Laryngeal involvement may result in a quavering voice.

    Cerebellar tumor

    An intention tremor is a cardinal sign of this disorder; related findings may include ataxia, nystagmus, incoordination, muscle weakness and atrophy, and hypoactive or absent deep tendon reflexes.

    General paresis

    This effect of neurosyphilis may cause an intention tremor accompanied by clonus, a positive Babinski’s sign, ataxia, Argyll Robertson pupils, and a diffuse, dull headache.

    Graves’ disease

    Fine tremors of the hand, nervousness, weight loss, fatigue, palpitations, dyspnea, and increased heat intolerance are typical signs and symptoms of this disorder. An enlarged thyroid gland (goiter) and exophthalmos are also characteristic.

    Hypercapnia

    Elevated partial pressure of carbon dioxide may result in a rapid, fine intention tremor. Other common findings include headache, fatigue, blurred vision, weakness, lethargy, and decreasing level of consciousness (LOC).

    Hypoglycemia

    Acute hypoglycemia may produce a rapid, fine intention tremor accompanied by confusion, weakness, tachycardia, diaphoresis, and cold, clammy skin. Early patient complaints typically include a mild generalized headache, profound hunger, nervousness, and blurred or double vision. The tremor may disappear as hypoglycemia worsens and hypotonia and decreased LOC become evident.

    Kwashiorkor

    Coarse intention and resting tremors may occur in the advanced stages of this disease. Examination reveals myoclonus, rigidity of all extremities, hyperreflexia, hepatomegaly, and pitting edema in the hands, feet, and sacral area. Other signs include a flat affect, pronounced hair loss, and dry, peeling skin.

    Multiple sclerosis (MS)

    An intention tremor that waxes and wanes may be an early sign of MS, but visual and sensory impairments are usually the earliest findings. Associated effects vary greatly and may include nystagmus, muscle weakness, paralysis, spasticity, hyperreflexia, ataxic gait, dysphagia, and dysarthria. Constipation, urinary frequency and urgency, incontinence, impotence, and emotional lability may also occur.

    Parkinson’s disease

    Tremors, a classic early sign of this degenerative disease, usually begin in the fingers and may eventually affect the foot, eyelids, jaw, lips, and tongue. The slow, regular, rhythmic resting tremor takes the form of flexion-extension or abduction-adduction of the fingers or hand, or pronation-supination of the hand. Flexion-extension of the fingers combined with abduction-adduction of the thumb is known as the characteristic pill-rolling tremor.

    Leg involvement produces flexion-extension foot movement. Lightly closing the eyelids causes them to flutter. The jaw may move up and down, and the lips may purse. The tongue, when protruded, may move in and out of the mouth in tempo with tremors elsewhere in the body. The rate of the tremor remains constant over time, but its amplitude varies.

    Other characteristic findings include cogwheel or lead-pipe rigidity, bradykinesia, propulsive gait with forward-leaning posture, monotone voice, masklike facies, drooling, dysphagia, dysarthria, and occasionally oculogyric crisis (eyes fix upward, with involuntary tonic movements) or blepharospasm (eyelids close completely).

    Porphyria

    Involvement of the basal ganglia in porphyria can produce a resting tremor with rigidity accompanied by chorea and athetosis. As the disease progresses, generalized seizures may appear along with aphasia and hemiplegia.

    Thalamic syndrome

    Central midbrain syndromes are heralded by contralateral ataxic tremors and other abnormal movements along with Weber’s syndrome (oculomotor palsy with contralateral hemiplegia), paralysis of vertical gaze, and stupor or coma.

    Anteromedial-inferior thalamic syndrome produces varying combinations of tremor, deep sensory loss, and hemiataxia. However, the main effect of this syndrome may be an extrapyramidal dysfunction, such as hemiballismus or hemichoreoathetosis.

    Thyrotoxicosis

    Neuromuscular effects of this disorder include a rapid, fine intention tremor of the hands and tongue, along with clonus, hyperreflexia, and Babinski’s reflex. Other common signs and symptoms include tachycardia, cardiac arrhythmias, palpitations, anxiety, dyspnea, diaphoresis, heat intolerance, weight loss despite increased appetite, diarrhea, an enlarged thyroid and, possibly, exophthalmos.

    Wernicke’s encephalopathy

    An intention tremor is an early sign of this thiamine deficiency. Other features include ocular abnormalities (such as gaze paralysis and nystagmus), ataxia, apathy, and confusion. Orthostatic hypotension and tachycardia may also develop.

    West Nile encephalitis

    This brain infection is caused by West Nile virus, a mosquito-borne flavivirus endemic in Africa, the Middle East, western Asia, and the United States. Mild infections are common and include fever, headache, and body aches, commonly accompanied by rash and swollen lymph glands. More severe infections are marked by headache, high fever, neck stiffness, stupor, disorientation, coma, tremors, occasional seizures, and paralysis. Death rarely occurs.

    Wilson’s disease

    This disorder of abnormal copper metabolism produces slow “wing-flapping” tremors in the arms and pill-rolling tremors in the hands; these tremors appear early in the disease and progressively worsen. The most characteristic sign, however, is Kayser-Fleischer rings—rusty brown rings around the corneas. Other signs and symptoms include incoordination, dysarthrial chorea, ataxia, muscle spasms and rigidity, abdominal distress, fatigue, personality changes, hypotension, syncope, and seizures. Liver and spleen enlargement, ascites, jaundice, and hyperpigmentation may also occur.

    Other causes

    Drugs

    Phenothiazines (particularly piperazine derivatives such as fluphenazine) and other antipsychotics may cause resting and pill-rolling tremors. Metoclopramide and metyrosine also cause these tremors occasionally. Lithium toxicity, sympathomimetics (such as terbutaline and pseudoephedrine), amphetamines, and phenytoin can all cause tremors that disappear when the dosage is decreased.

    Herb Alert

    i>Herbal products, such as ephedra (ma huang), have been known to cause serious adverse reactions, which may include tremors. (Note: The FDA has banned the sale of dietary supplements containing ephedra because they pose an unreasonable risk of injury or illness.)

    Manganese toxicity

    Early signs of manganese poisoning include resting tremor, chorea, propulsive gait, cogwheel rigidity, personality changes, amnesia, and masklike facies.

    Mercury poisoning

    The chronic form of mercury poisoning is characterized by irritability, copious amounts of saliva, loose teeth, gum disease, slurred speech, and tremors.

    » READ BOOK EXCERPT ONLINE »

    Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

    Asterixis [Liver flap, flapping tremor]: Medical causes
    (Professional Guide to Signs & Symptoms (Fifth Edition))

    Hepatic encephalopathy

    A life-threatening disorder, hepatic encephalopathy initially causes mild personality changes and a slight tremor. The tremor progresses to asterixis—a hallmark of hepatic encephalopathy—and is accompanied by lethargy, aberrant behavior, and apraxia. Eventually, the patient becomes stuporous and displays hyperventilation. After slipping into a coma, the patient exhibits characteristic hyperactive reflexes, positive Babinski’s reflex, and fetor hepaticus. He also may experience bradycardia, decreased respirations, and seizures.

    Respiratory insufficiency, severe

    Characterized by life-threatening respiratory acidosis, severe respiratory insufficiency initially produces headache, restlessness, confusion, apprehension, and decreased reflexes. Eventually, the patient becomes somnolent and may demonstrate asterixis before slipping into a coma. Associated signs and symptoms of respiratory insufficiency include difficulty breathing and rapid, shallow respirations. The patient may be hypertensive in early disease but hypotensive later.

    Uremic syndrome

    Uremic syndrome is a life-threatening disorder that initially causes lethargy, somnolence, confusion, disorientation, behavior changes, and irritability. Eventually, signs and symptoms appear in diverse body systems. Asterixis is accompanied by stupor, paresthesia, muscle twitching, fasciculations, and footdrop. Other signs and symptoms include polyuria and nocturia followed by oliguria and then anuria, elevated blood pressure, signs of heart failure and pericarditis, Kussmaul’s respirations, anorexia, nausea, vomiting diarrhea, GI bleeding, weight loss, ammonia breath odor, and metallic taste (dysgeusia).

    Other causes

    Drugs

    Certain drugs, such as the anticonvulsant phenytoin, may cause asterixis.

    » READ BOOK EXCERPT ONLINE »

    Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

    Tremor/InvoluntaryMovements: Differential Overview
    (Field Guide to Bedside Diagnosis)

    Tremor

    ❑ Anxiety

    ❑ Physiologic tremor

    ❑ Essential tremor

    ❑ Parkinson disease

    ❑ Cerebellar disease

    ❑ Hyperthyroidism

    ❑ Opiate withdrawal

    ❑ Myoclonus

    ❑ Multiple sclerosis

    ❑ Amyotrophic lateral sclerosis

    Involuntary Movements

    ❑ Tics

    ❑ Drugs

    ❑ Systemic lupus erythematosus

    ❑ Rheumatic fever

    ❑ Huntington disease

    ❑ Tourette syndrome

    ❑ Wilson disease

    » READ BOOK EXCERPT ONLINE »

    Source: Field Guide to Bedside Diagnosis, 2007

    Tremors: Medical causes
    (Signs & Symptoms: A 2-in-1 Reference for Nurses)

    Alcohol withdrawal syndrome

    Acute alcohol withdrawal after long-term dependence may first be manifested by resting and intention tremors that appear as soon as 7 hours after the last drink and progressively worsen. Other early signs and symptoms include diaphoresis, tachycardia, elevated blood pressure, anxiety, restlessness, irritability, insomnia, headache, nausea, and vomiting. Severe withdrawal may produce profound tremors, agitation, confusion, hallucinations and, possibly, seizures.

    Alkalosis

    Severe alkalosis may produce a severe intention tremor along with twitching, carpopedal spasms, agitation, diaphoresis, and hyperventilation. The patient may complain of dizziness, tinnitus, palpitations, and peripheral and circumoral paresthesia.

    Cerebellar tumor

    An intention tremor is a cardinal sign of a cerebellar tumor; related findings may include ataxia, nystagmus, incoordination, muscle weakness and atrophy, and hypoactive or absent deep tendon reflexes.

    Graves’ disease

    Fine tremors of the hand, nervousness, weight loss, fatigue, palpitations, dyspnea, and increased heat intolerance are some of the typical signs of Graves’disease. It’s also characterized by an enlarged thyroid gland (goiter) and exophthalmos.

    Hypercapnia

    Hypercapnia (elevated partial pressure of carbon dioxide) may result in a rapid, fine intention tremor. Other common findings include headache, fatigue, blurred vision, weakness, lethargy, and decreased level of consciousness (LOC).

    Hypoglycemia

    Acute hypoglycemia may produce a rapid, fine intention tremor accompanied by confusion, weakness, tachycardia, diaphoresis, and cold, clammy skin. Early patient complaints typically include mild generalized headache, profound hunger, nervousness, and blurred or double vision. The tremor may disappear as hypoglycemia worsens and hypotonia and decreased LOC become evident.

    Kwashiorkor

    Coarse intention and resting tremors may occur in the advanced stages of kwashiorkor. Examination reveals myoclonus, rigidity of all extremities, hyperreflexia, hepatomegaly, and pitting edema in the hands, feet, and sacral area. Other signs include a flat affect, pronounced hair loss, and dry, peeling skin.

    Multiple sclerosis

    An intention tremor that waxes and wanes may be an early sign of multiple sclerosis. Commonly, visual and sensory impairments are the earliest findings. Associated effects vary greatly and may include nystagmus, muscle weakness, paralysis, spasticity, hyperreflexia, ataxic gait, dysphagia, and dysarthria. Constipation, urinary frequency and urgency, incontinence, impotence, and emotional lability may also occur.

    Parkinson’s disease

    Tremors, a classic early sign of Parkinson’s disease, usually begin in the fingers and may eventually affect the foot, eyelids, jaw, lips, and tongue. The slow, regular, rhythmic resting tremor takes the form of flexion-extension or abduction-adduction of the fingers or hand, or pronation-supination of the hand. Flexion-extension of the fingers combined with abduction-adduction of the thumb yields the characteristic pill-rolling tremor.

    Leg involvement produces flexion-extension foot movement. Lightly closing the eyelids causes them to flutter. The jaw may move up and down, and the lips may purse. The tongue, when protruded, may move in and out of the mouth in tempo with tremors elsewhere in the body. The rate of the tremor holds constant over time, but its amplitude varies.

    Other characteristic findings include cogwheel or lead-pipe rigidity, bradykinesia, propulsive gait with forward-leaning posture, monotone voice, masklike facies, drooling, dysphagia, dysarthria, and occasionally oculogyric crisis (eyes fix upward, with involuntary tonic movements) or blepharospasm (eyelids close completely).

    Porphyria

    Involvement of the basal ganglia in porphyria can produce a resting tremor with rigidity, accompanied by chorea and athetosis. As the disease progresses, generalized seizures may appear along with aphasia and hemiplegia.

    Thalamic syndrome

    Central midbrain syndromes are heralded by contralateral ataxic tremors and other abnormal movements, along with Weber’s syndrome (oculomotor palsy with contralateral hemiplegia), paralysis of vertical gaze, and stupor or coma.

    Anteromedial-inferior thalamic syndrome produces varying combinations of tremor, deep sensory loss, and hemiataxia. However, the main effect of this syndrome may be an extrapyramidal dysfunction, such as hemiballismus or hemichoreoathetosis.

    Thyrotoxicosis

    Neuromuscular effects of thyrotoxicosis include a rapid, fine intention tremor of the hands and tongue, along with clonus, hyperreflexia, and Babinski’s reflex. Other common signs and symptoms include tachycardia, cardiac arrhythmias, palpitations, anxiety, dyspnea, diaphoresis, heat intolerance, weight loss despite increased appetite, diarrhea, an enlarged thyroid and, possibly, exophthalmos.

    Wernicke’s disease

    An intention tremor is an early sign of Wernicke’s disease. Other features of Wernicke’s disease include ocular abnormalities (such as gaze paralysis and nystagmus), ataxia, apathy, and confusion. Orthostatic hypotension and tachycardia may also develop.

    West Nile encephalitis

    In West Nile encephalitis, mild infections are common and include fever, headache, and body aches, commonly accompanied by rash and swollen lymph glands. More severe infections are marked by headache, high fever, neck stiffness, stupor, disorientation, coma, tremors, occasional seizures, paralysis and, rarely, death.

    Other causes

    Drugs

    Phenothiazines (particularly piperazine derivatives such as fluphenazine) and other antipsychotics may cause resting and pill-rolling tremors. Infrequently, metoclopramide and metyrosine also cause these tremors. Lithium toxicity, sympathomimetics (such as terbutaline and pseudoephedrine), amphetamines, and phenytoin can all cause tremors that disappear with dose reduction.

    Manganese toxicity

    Early signs of manganese poisoning include resting tremor, chorea, propulsive gait, cogwheel rigidity, personality changes, amnesia, and masklike facies.

    Mercury poisoning

    Mercury is a chronic form of poisoning that’s characterized by irritability, copious amounts of saliva, loose teeth, gum disease, slurred speech and tremors.

    » READ BOOK EXCERPT ONLINE »

    Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

    Tremors: Medical causes
    (Nursing: Interpreting Signs and Symptoms)

    Alcohol withdrawal syndrome.Acute alcohol withdrawal after long-term dependence may first be manifested by resting and intention tremors that appear as soon as 7 hours after the last drink and progressively worsen. Other early signs and symptoms include diaphoresis, tachycardia, elevated blood pressure, anxiety, restlessness, irritability, insomnia, headache, nausea, and vomiting. Severe withdrawal may produce profound tremors, agitation, confusion, hallucinations and, possibly, seizures.

    Alkalosis.Severe alkalosis may produce a severe intention tremor along with twitching, carpopedal spasms, agitation, diaphoresis, and hyperventilation. The patient may complain of dizziness, tinnitus, palpitations, and peripheral and circumoral paresthesia.

    Benign familial essential tremor.Benign familial essential tremor produces a bilateral essential tremor that typically begins in the fingers and hands and may spread to the head, jaw, lips, and tongue. Laryngeal involvement may result in a quavering voice.

    Cerebellar tumor.An intention tremor is a cardinal sign of cerebellar tumor; related findings may include ataxia, nystagmus, incoordination, muscle weakness and atrophy, and hypoactive or absent deep tendon reflexes.

    Graves' disease.Fine tremors of the hand, nervousness, weight loss, fatigue, palpitations, dyspnea, and increased heat intolerance are some of the typical signs of Graves' disease. It's also characterized by an enlarged thyroid (goiter) and exophthalmos.

    Hypercapnia.Elevated partial pressure of carbon dioxide may result in a rapid, fine intention tremor. Other common findings include headache, fatigue, blurred vision, weakness, lethargy, and decreasing level of consciousness (LOC).

    Hypoglycemia.Acute hypoglycemia may produce a rapid, fine intention tremor accompanied by confusion, weakness, tachycardia, diaphoresis, and cold, clammy skin. Early patient complaints typically include a mild generalized headache, profound hunger, nervousness, and blurred or double vision. The tremor may disappear as hypoglycemia worsens and hypotonia and decreased LOC become evident.

    Multiple sclerosis (MS).An intention tremor that waxes and wanes may be an early sign of MS. Commonly, vision and sensory impairments are the earliest findings. Associated effects vary greatly and may include nystagmus, muscle weakness, paralysis, spasticity, hyperreflexia, ataxic gait, dysphagia, and dysarthria. Constipation, urinary frequency and urgency, incontinence, impotence, and emotional lability may also occur.

    Parkinson's disease.Tremors, a classic early sign of Parkinson's disease, usually begin in the fingers and may eventually affect the foot, eyelids, jaw, lips, and tongue. The slow, regular, rhythmic resting tremor takes the form of flexion-extension or abduction-adduction of the fingers or hand, or pronation-supination of the hand. Flexion-extension of the fingers combined with abduction-adduction of the thumb yields the characteristic pill-rolling tremor.

    Leg involvement produces flexion-extension foot movement. Lightly closing the eyelids causes them to flutter. The jaw may move up and down, and the lips may purse. The tongue, when protruded, may move in and out of the mouth in tempo with tremors elsewhere in the body. The rate of the tremor holds constant over time, but its amplitude varies.

    Other characteristic findings include cogwheel or lead-pipe rigidity, bradykinesia, propulsive gait with forward-leaning posture, monotone voice, masklike facies, drooling, dysphagia, dysarthria, and occasionally oculogyric crisis (eyes fix upward, with involuntary tonic movements) or blepharospasm (eyelids close completely).

    Thalamic syndrome.Central midbrain syndromes are heralded by contralateral ataxic tremors and other abnormal movements, along with Weber's syndrome (oculomotor palsy with contralateral hemiplegia), paralysis of vertical gaze, and stupor or coma.

    Anteromedial-inferior thalamic syndrome produces varying combinations of tremor, deep sensory loss, and hemiataxia. However, the main effect of this syndrome may be an extrapyramidal dysfunction, such as hemiballismus or hemichoreoathetosis.

    Thyrotoxicosis.Neuromuscular effects of thyrotoxicosis include a rapid, fine intention tremor of the hands and tongue, along with clonus, hyperreflexia, and Babinski's reflex. Other common signs and symptoms include tachycardia, cardiac arrhythmias, palpitations, anxiety, dyspnea, diaphoresis, heat intolerance, weight loss despite increased appetite, diarrhea, an enlarged thyroid and, possibly, exophthalmos.

    Wernicke's disease.An intention tremor is an early sign of Wernicke's disease. Other features include ocular abnormalities (such as gaze paralysis and nystagmus), ataxia, apathy, and confusion. Orthostatic hypotension and tachycardia may also develop.

    West Nile encephalitis.This brain infection causes fever, headache, and body aches, commonly accompanied by a rash and swollen lymph glands. More severe infections are marked by headache, high fever, neck stiffness, stupor, disorientation, coma, tremors, occasional seizures, paralysis and, rarely, death.

    Other causes

    Drugs.Phenothiazines (particularly piperazine derivatives such as fluphenazine) and other antipsychotics may cause resting and pill-rolling tremors. Less commonly, metoclopramide and metyrosine also cause these tremors. Lithium toxicity, sympathomimetics (such as terbutaline and pseudoephedrine), amphetamines, and phenytoin can all cause tremors that disappear with dose reduction.

    » READ BOOK EXCERPT ONLINE »

    Source: Nursing: Interpreting Signs and Symptoms, 2007

    Asterixis [Liver flap, flapping tremor]: Medical causes
    (Nursing: Interpreting Signs and Symptoms)

    Hepatic encephalopathy.A life-threatening disorder, hepatic encephalopathy initially causes mild personality changes and a slight tremor. The tremor progresses into asterixis—a hallmark of hepatic encephalopathy—and is accompanied by lethargy, aberrant behavior, and apraxia. Eventually, the patient becomes stuporous and displays hyperventilation. When he slips into a coma, hyperactive reflexes, a positive Babinski's sign, and fetor hepaticus are characteristic signs. The patient may also experience bradycardia, decreased respirations, and seizures.

    Severe respiratory insufficiency.Characterized by life-threatening respiratory acidosis, severe respiratory insufficiency initially produces headache, restlessness, confusion, apprehension, and decreased reflexes. Eventually, the patient becomes somnolent and may demonstrate asterixis before slipping into a coma. Associated signs and symptoms of respiratory insufficiency include difficulty breathing and rapid, shallow respirations. The patient may be hypertensive in early disease but hypotensive later.

    Uremic syndrome.A life-threatening disorder, uremic syndrome initially causes lethargy, somnolence, confusion, disorientation, behavior changes, and irritability. Eventually, signs and symptoms appear in diverse body systems. Asterixis is accompanied by stupor, paresthesia, muscle twitching, fasciculations, and footdrop. Other signs and symptoms include polyuria and nocturia followed by oliguria and, then, anuria; elevated blood pressure; signs of heart failure and pericarditis; deep, gasping respirations (Kussmaul's respirations); anorexia; nausea; vomiting; diarrhea; GI bleeding; weight loss; ammonia breath odor; and metallic taste (dysgeusia).

    Other causes

    Drugs.Certain drugs, such as the anticonvulsant phenytoin, may cause asterixis.

    » READ BOOK EXCERPT ONLINE »

    Source: Nursing: Interpreting Signs and Symptoms, 2007


     » Next page: Symptoms of Tremor

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