Neurology Book

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Physiologic Tremor

Aka: Physiologic Tremor, Enhanced Physiologic Tremor
  1. See Also
    1. Tremor
    2. Postural Tremor
  2. Exam: Findings
    1. Postural Tremor
    2. Normal variant (present in most normal patients)
    3. Example: Hold paper with outstretched arm
    4. Characteristics
      1. Low amplitude
      2. Frequency
        1. Hands: Rapid (8-12 Hz)
        2. Other parts: Intermediate (6.5 Hz)
  3. History: Provocative (Enhanced Physiologic Tremor)
    1. Emotions (Anxiety, Stress, or Fear)
    2. Exercise
    3. Fatigue
    4. Hypoglycemia
    5. Hypothermia
    6. Hyperthyroidism
    7. Alcohol Withdrawal
    8. Benzodiazepine Withdrawal
    9. Medications
      1. Albuterol
      2. Caffeine
      3. Fluoxetine (Prozac)
      4. Haloperidol (Haldol)
      5. Tricyclic Antidepressants (e.g. Amitriptyline)
      6. Lithium
      7. Methylphenidate (Ritalin)
      8. Metoclopramide (Reglan)
      9. Phenylpropanolamine
      10. Pseudoephedrine
      11. Synthroid
      12. Theophylline
      13. Carbamazepine (Tegretol)
      14. Valproic Acid
  4. History: Palliative factors reducing Tremor
    1. Alcohol
    2. Benzodiazepines
    3. Beta Blockers (e.g. Propranolol)
    4. Primidone (Mysoline)
  5. Labs: Not indicated unless atypical case or severe Tremor
    1. Chemistry Panel including Glucose
    2. Liver Function Tests
    3. Thyroid Stimulating Hormone (TSH)
  6. Management
    1. Eliminate exacerbating factors
    2. Decrease Caffeine

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