Tremor differential diagnosis

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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

  • Differentiating the cause of tremor from other diseases on the basis of the type of tremor, associated signs, and symptoms.[1].
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, low amplitude Enahanced with drug and toxins, no neurological feature
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. 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.

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