Neurology Book

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Tremor

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  1. Definition
    1. Body part oscillates around point in space
  2. Differential Diagnosis
    1. Choreoathetosis
    2. Dystonia
    3. Clonus
  3. Frequency
    1. Slow tremor: 3-5 Hz (e.g. Rest Tremor)
    2. Intermediate: 5-8 Hz (e.g. Isometric Tremor)
    3. Rapid tremor: 9-12 Hz (e.g. Postural Tremor)
  4. Amplitude
    1. Fine Tremor: Barely noticeable (e.g. Postural Tremor)
    2. Medium
    3. Coarse Tremor: Large displacement (e.g. Rest Tremor)
  5. Classification
    1. Rest Tremor
      1. Patient attempts to maintain body position at rest
    2. Postural Tremor
      1. Patient attempts to maintain posture against gravity
    3. Action Tremor
      1. Kinetic Tremor
      2. Isometric Tremor
      3. Intention Tremor
      4. Task-specific tremor
  6. Examination
    1. Characterize tremor
      1. Record part of body with tremor
      2. Provocative and palliative factors
      3. Tremor frequency (fast or slow tremor)
      4. Tremor amplitude (coarse or fine tremor)
    2. Observe with hands resting in lap (Rest Tremor)
    3. Observe writing or drinking (Action Tremor)
    4. Perform finger-nose-finger test (Intention Tremor)
    5. Draw a spiral (Archimedes Spiral in Essential Tremor)
    6. Focus exam based on tremor type
      1. Action Tremor
      2. Postural Tremor
      3. Rest Tremor
  7. Labs
    1. Individualize work-up per tremor type
    2. Chemistry panel (e.g. Chem8)
    3. Complete Blood Count (CBC)
    4. Thyroid Function Tests
  8. Causes (See specific tremor types)
    1. Physiologic Tremor
    2. Drug-Induced Tremor
    3. Pathologic Tremor
      1. Essential Tremor
      2. Parkinson's Disease
      3. Multiple Sclerosis
      4. Brain Tumor
      5. Brain abscess
      6. Peripheral Neuropathy
      7. Pheochromocytoma
      8. Psychogenic Tremor
      9. Thyrotoxicosis
      10. Alcohol Abuse or Drug-Induced Tremor
      11. Hypoglycemia (tremor 3 hours after eating)
      12. Panic Disorder
  9. Resources
    1. International Tremor Foundation
      1. Overland Park, Kansas
      2. Phone: (913) 341-3880
    2. See Parkinson's Disease Resources
  10. Reference
    1. Charles (1999) Am Fam Physician 59(6):1565
    2. Habib-ur-Rehman (2000) Arch Intern Med 160(16):2438
    3. Smaga (2003) Am Fam Physician 68:1545
    4. Velickovic (2002) {a 6611} 57(7):32

Tremor (C0040822)

Definition (MSH)Cyclical movement of a body part that can represent either a physiologic process or a manifestation of disease. Intention or action tremor, a common manifestation of CEREBELLAR DISEASES, is aggravated by movement. In contrast, resting tremor is maximal when there is no attempt at voluntary movement, and occurs as a relatively frequent manifestation of PARKINSON DISEASE.
Definition (CSP)involuntary trembling or quivering.
Definition (NCI)The shaking movement of the whole body or just a certain part of it, often caused by problems of the neurons responsible for muscle action.
ConceptsSign or Symptom (T184)
ICD9781.0
EnglishHas a tremor, Shakes, Shaking, Shaking all over, Shaking/Tremors, The shakes, Tremor, Tremor symptom, Tremors, Tremors/shaking
Spanishsacudida, temblor
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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