![]() A tremor is also seen in this patient’s face from the same disease. If you look closely even his left leg has a tremor at rest. Here's a resting tremor in a patient with severe Parkinson's disease. Causes include Parkinson's disease, drug-induced parkinsonism and less common supranuclear palsy. The resting tremor is simply examined at rest. If you listen really closely you can hear slight variation in this patient's voice. Patients with essential tremor will oftentimes have a shakiness in their voice as well. As you can see here arm straight out and held up in the air the tremor is persistent (as seen better here when zoomed in). This is an actual patient from Stanford hospital with a history of familial essential tremor. ![]() Causes include a normal physiologic tremor which can be increased in certain states such as sleep deprivation, too much caffeine or nicotine, alcohol withdrawal, increased metabolic states such as in hyperthyroidism and essential tremor. The postural tremor is easy to find by asking your patient to hold their arms out. Let's start by reviewing the different categories of tremor. The goal of this video is to help you figure out what's causing your patient's tremor. Welcome to a Stanford Medicine 25 video on the approach to tremor. Note: other resting tremors include Wilson's Disease and severe essential tremor (ET is usually postural but when servere can be seen at rest or even with movement).Encephalitis (HIV/AIDS, neurosyphilis, PML, toxoplasmosis).Drugs: antipsychotic agents, metoclopramide, prochloperazine.Idiopathic parkinson's disease: usually starts in one hand then spreads to other limbs.asking patient to do math) and increase with anxiety or emotional excitement raising arm) and increase with mental activity (e.g. May decrease with voluntary activity (e.g.Most common cause of a resting tremor that usually involves the distal muscles (e.g.Titubation refers to tremor of the head (and sometimes trunk) due to cerebellar disease.Unlike the cerebrum, cerebellar disease causes problems on the SAME SIDE of the body as the the cerebellar lesion.Seen in any process that causes damage to the cerebrellum (stroke, tumor, multiple sclerosis, chronic alcohol abuse, certain medications).Usually associated with other cerebellar findings.Slow action tremor that most commonly occurs with purposeful movement (such as in doing finger to nose test).Differentiate from Parkinson by noting absence of resting tremor, rigidity, bradykinesia, etc.Classically, tremor decreases with EtOH, worsens with stress.Classically affects head and/or speech.Mainly a postural tremor but if worsened, will occur at rest. ![]()
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