Tremor differential diagnosis: Difference between revisions

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  | [[Parkinson’s disease]] || [[Resting Tremor]] - Unilateral onset || [[Bradykinesia]], [[micrographia]], [[stooped posture]], [[ataxia]], [[rigidity]], [[imbalance]], [[depression]], [[apathy]], decreases with voluntary movements
  | [[Parkinson’s disease]] || [[Resting Tremor]] - Unilateral onset || [[Bradykinesia]], [[micrographia]], [[stooped posture]], [[ataxia]], [[rigidity]], [[imbalance]], [[depression]], [[apathy]], decreases with voluntary movements
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  | [[Physiologic Tremor]] || Postural tremor - High [[frequency]], low [[amplitude]] || Enahanced with [[drug]] and [[toxins]], no [[neurological]] feature
  | [[Physiologic Tremor]] || Postural tremor - High [[frequency]] 8–10 Hz, low [[amplitude]], irregular oscillations || Tremor occurs while maintaining a posture and mostly disappears if [[eyes]] are closed or a load is placed on the [[muscles]]. Mild physiologic tremors may be present in the general [[population]] normally.
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| Enhanced Physiologic Tremor]] ||Increased amplitude  ||Physiolgi tremor enhanced due to [[fatigue]], [[sleep deprivation]], [[drugs]], [[endocrine disorders]], [[caffeine]], [[stress]].
  | [[Cerebellar Tremor]] || [[Intention tremor]] - Low [[frequency]] <4 Hz || Occurs in [[multiple sclerosis]], [[stroke]], [[brainstem]] [[tumor]], or [[cerebellar]] [[trauma]]. May feature [[ataxia]], [[dysmetria]], [[dysdiadochokinesia]], and [[dysarthria]].
  | [[Cerebellar Tremor]] || [[Intention tremor]] - Low [[frequency]] <4 Hz || Occurs in [[multiple sclerosis]], [[stroke]], [[brainstem]] [[tumor]], or [[cerebellar]] [[trauma]]. May feature [[ataxia]], [[dysmetria]], [[dysdiadochokinesia]], and [[dysarthria]].
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Revision as of 01:26, 26 January 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Zehra Malik, M.B.B.S[2]

Overview

Tremor must be differentiated from diseases that cause involuntary movement: myoclonus, clonus, asterixis, and epilepsia partialis continua. The cause of tremor must also be differentiated from other conditions that cause tremor: essential tremor, physiological tremor, Parkinson's disease, cerebellar tremor, orthostatic tremor.

Differentiating Tremor from other Diseases

Common Cause of Tremor Differentiating Feature of Tremor Main Feature of Disease
Essential tremor Postural Tremor - [Frequency]] 4–12 Hz, Bilateral onset gait ataxia, vestibulocerebellar involvement, reduced by alcohol, family history, stress/fatigue can increase tremor amplitude, increases with voluntary movements
Parkinson’s disease Resting Tremor - Unilateral onset Bradykinesia, micrographia, stooped posture, ataxia, rigidity, imbalance, depression, apathy, decreases with voluntary movements
Physiologic Tremor Postural tremor - High frequency 8–10 Hz, low amplitude, irregular oscillations Tremor occurs while maintaining a posture and mostly disappears if eyes are closed or a load is placed on the muscles. Mild physiologic tremors may be present in the general population normally.
Enhanced Physiologic Tremor]] Increased amplitude Physiolgi tremor enhanced due to fatigue, sleep deprivation, drugs, endocrine disorders, caffeine, stress. Cerebellar Tremor Intention tremor - Low frequency <4 Hz Occurs in multiple sclerosis, stroke, brainstem tumor, or cerebellar trauma. May feature ataxia, dysmetria, dysdiadochokinesia, and dysarthria.
Drug Induced Tremor Can enhance rest, action, postural tremors Amiodarone, bronchodilators, lithium, metoclopramide, neuroleptics, theophylline, valproate
Orthostatic Tremor Essential tremor variant, high frequency 14 Hz-18 Hz Occurs in the legs on standing and is relieved by sitting down

References

  1. Bhidayasiri R (2005). "Differential diagnosis of common tremor syndromes". Postgrad Med J. 81 (962): 756–62. doi:10.1136/pgmj.2005.032979. PMC 1743400. PMID 16344298.
  2. Deuschl G, Elble R (2009). "Essential tremor--neurodegenerative or nondegenerative disease towards a working definition of ET". Mov Disord. 24 (14): 2033–41. doi:10.1002/mds.22755. PMID 19750493.
  3. Smaga S (2003). "Tremor". Am Fam Physician. 68 (8): 1545–52. PMID 14596441.
  4. Crawford P, Zimmerman EE (2011). "Differentiation and diagnosis of tremor". Am Fam Physician. 83 (6): 697–702. PMID 21404980.

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