Tremor history and symptoms: Difference between revisions
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{{Tremor}} | {{Tremor}} | ||
{{CMG}}; {{AE}} {{ | {{CMG}}; {{AE}} {{ZMalik}} | ||
==Overview== | ==Overview== | ||
Tremor is the most common involuntary movement disorder. in the primary care setting the most common causes of tremors are [[essential tremors]], [[Parkinson's disease]] and enhanced physiologic tremor. | Tremor is the most common involuntary movement disorder. in the primary care setting the most common [[causes]] of tremors are [[essential tremors]], [[Parkinson's disease]] and enhanced physiologic tremor. | ||
==History and Symptoms== | ==History and Symptoms== | ||
*The majority of patients with tremor have variable associated [[symptoms]], depending on the underlying [[etiology]]. | |||
*The majority of [[patients]] with tremor have variable associated [[symptoms]], depending on the underlying [[etiology]]. | |||
===History=== | ===History=== | ||
It is important to investigate the following features of tremor in patients history in order to reach the underlying cause of tremor<ref name="pmid16344298">{{cite journal| author=Bhidayasiri R| title=Differential diagnosis of common tremor syndromes. | journal=Postgrad Med J | year= 2005 | volume= 81 | issue= 962 | pages= 756-62 | pmid=16344298 | doi=10.1136/pgmj.2005.032979 | pmc=1743400 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16344298 }} </ref><ref name="pmid21404980">{{cite journal| author=Crawford P, Zimmerman EE| title=Differentiation and diagnosis of tremor. | journal=Am Fam Physician | year= 2011 | volume= 83 | issue= 6 | pages= 697-702 | pmid=21404980 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21404980 }} </ref>: | It is important to investigate the following features of tremor in patients history in order to reach the underlying cause of tremor: <ref name="pmid16344298">{{cite journal| author=Bhidayasiri R| title=Differential diagnosis of common tremor syndromes. | journal=Postgrad Med J | year= 2005 | volume= 81 | issue= 962 | pages= 756-62 | pmid=16344298 | doi=10.1136/pgmj.2005.032979 | pmc=1743400 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16344298 }} </ref><ref name="pmid21404980">{{cite journal| author=Crawford P, Zimmerman EE| title=Differentiation and diagnosis of tremor. | journal=Am Fam Physician | year= 2011 | volume= 83 | issue= 6 | pages= 697-702 | pmid=21404980 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21404980 }} </ref><ref name="pmid27994349">{{cite journal| author=Sharma S, Pandey S| title=Approach to a tremor patient. | journal=Ann Indian Acad Neurol | year= 2016 | volume= 19 | issue= 4 | pages= 433-443 | pmid=27994349 | doi=10.4103/0972-2327.194409 | pmc=5144461 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27994349 }} </ref> | ||
*Mode of Onset, Unilateral or Bilateral | |||
*[[Mode of Onset]], [[Unilateral]] or [[Bilateral]] | |||
*Type of tremor (resting or action) | *Type of tremor (resting or action) | ||
*Symmetric or Asymmetric | *Symmetric or Asymmetric | ||
*Associated [[signs]] and [[symptoms]] | *Associated [[signs]] and [[symptoms]] | ||
*Aggravating and relieving factors | *Aggravating and relieving factors | ||
*[[Medications]] | |||
*[[Family history]] | |||
===Common Symptoms=== | ===Common Symptoms=== | ||
*Common associated [[symptoms]] of [[essential tremor]] include: | *Common associated [[symptoms]] of [[essential tremor]] include: | ||
**Tremor in [[hands]] and [[arms]] bilaterally | **Tremor in [[hands]] and [[arms]] bilaterally | ||
| Line 26: | Line 31: | ||
**Releived from [[alcohol]] | **Releived from [[alcohol]] | ||
**Other [[neurologic]] [[signs]] are absent | **Other [[neurologic]] [[signs]] are absent | ||
**[[Essential tremor]] is diagnosed according to International Parkinson and Movement Disorder Society (IPMDS) guidelines<ref name="pmid29193359">{{cite journal| author=Bhatia KP, Bain P, Bajaj N, Elble RJ, Hallett M, Louis ED | display-authors=etal| title=Consensus Statement on the classification of tremors. from the task force on tremor of the International Parkinson and Movement Disorder Society. | journal=Mov Disord | year= 2018 | volume= 33 | issue= 1 | pages= 75-87 | pmid=29193359 | doi=10.1002/mds.27121 | pmc=6530552 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29193359 }} </ref>: | |||
***Bilateral action tremor of [[upper limbs]] | |||
***Absence of other [[neurological]] [[signs]] | |||
***Long duration, more than 3 years | |||
***Absence or presence of tremor in other locations | |||
*Common associated [[symptoms]] of [[Parkinsons Disease]] include: | *Common associated [[symptoms]] of [[Parkinsons Disease]] include: | ||
**Tremor decreases in intensity with voluntary movement | **Tremor decreases in intensity with voluntary movement | ||
| Line 40: | Line 51: | ||
===Less Common Symptoms=== | ===Less Common Symptoms=== | ||
Less common causes of tremor include<ref name="pmid16344298">{{cite journal| author=Bhidayasiri R| title=Differential diagnosis of common tremor syndromes. | journal=Postgrad Med J | year= 2005 | volume= 81 | issue= 962 | pages= 756-62 | pmid=16344298 | doi=10.1136/pgmj.2005.032979 | pmc=1743400 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16344298 }} </ref><ref name="pmid14596441">{{cite journal| author=Smaga S| title=Tremor. | journal=Am Fam Physician | year= 2003 | volume= 68 | issue= 8 | pages= 1545-52 | pmid=14596441 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14596441 }} </ref> | Less common causes of tremor include: <ref name="pmid16344298">{{cite journal| author=Bhidayasiri R| title=Differential diagnosis of common tremor syndromes. | journal=Postgrad Med J | year= 2005 | volume= 81 | issue= 962 | pages= 756-62 | pmid=16344298 | doi=10.1136/pgmj.2005.032979 | pmc=1743400 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16344298 }} </ref><ref name="pmid14596441">{{cite journal| author=Smaga S| title=Tremor. | journal=Am Fam Physician | year= 2003 | volume= 68 | issue= 8 | pages= 1545-52 | pmid=14596441 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14596441 }} </ref> | ||
*[[Stroke]]: Tremor [[acute]] in onset, [[headache]], [[vertigo]], [[imbalance]]. | *[[Stroke]]: Tremor [[acute]] in onset, [[headache]], [[vertigo]], [[imbalance]]. | ||
*[[Orthostatic]] Tremor: Shaking of [[legs]] upon standing, subjective feeling on [[imbalance]] and fall. Relieved by sitting down. | *[[Orthostatic]] Tremor: Shaking of [[legs]] upon standing, subjective feeling on [[imbalance]] and fall. Relieved by sitting down. | ||
| Line 47: | Line 59: | ||
*[[Neuropathic]]: Tremor, [[numbness]], [[tingling]], [[weakness]] | *[[Neuropathic]]: Tremor, [[numbness]], [[tingling]], [[weakness]] | ||
*[[Panic disorder]]: Tremor, [[suffocation]], [[chest tightness]], [[palpitations]] | *[[Panic disorder]]: Tremor, [[suffocation]], [[chest tightness]], [[palpitations]] | ||
*[[Benzodiazepine]] [[withdrawal]]: Hand tremor, [[sleep]] disturbance, [[irritability]], [[sweating]], [[nausea]], difficulty concentrating. | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Neurology]] | |||
[[Category:Primary care]] | |||
[[Category:Signs and symptoms]] | |||
[[Category: | [[Category:Medicine]] | ||
Latest revision as of 20:40, 18 February 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 is the most common involuntary movement disorder. in the primary care setting the most common causes of tremors are essential tremors, Parkinson's disease and enhanced physiologic tremor.
History and Symptoms
- The majority of patients with tremor have variable associated symptoms, depending on the underlying etiology.
History
It is important to investigate the following features of tremor in patients history in order to reach the underlying cause of tremor: [1][2][3]
- Mode of Onset, Unilateral or Bilateral
- Type of tremor (resting or action)
- Symmetric or Asymmetric
- Associated signs and symptoms
- Aggravating and relieving factors
- Medications
- Family history
Common Symptoms
- Common associated symptoms of essential tremor include:
- Tremor in hands and arms bilaterally
- Symmetric tremors
- Haed nodding
- Aggravated by stress, hands outstretched
- Releived from alcohol
- Other neurologic signs are absent
- Essential tremor is diagnosed according to International Parkinson and Movement Disorder Society (IPMDS) guidelines[4]:
- Bilateral action tremor of upper limbs
- Absence of other neurological signs
- Long duration, more than 3 years
- Absence or presence of tremor in other locations
- Common associated symptoms of Parkinsons Disease include:
- Tremor decreases in intensity with voluntary movement
- Bradykinesia
- Stooped posture
- Cogwheel rigidity
- Micrographia
- Ataxia
- Apathy
- Common associated symptoms of enhanced physiologic tremor include:
- Occurs while maintaining position against gravity
- Enhanced with sympathetic stimulation (e.g., stress)
- Normal neurological examination
Less Common Symptoms
Less common causes of tremor include: [1][5]
- Stroke: Tremor acute in onset, headache, vertigo, imbalance.
- Orthostatic Tremor: Shaking of legs upon standing, subjective feeling on imbalance and fall. Relieved by sitting down.
- Hyperthyroidism: Postural tremor, weight loss, palpitations, excessive sweating, nervousness, feeling overheated.
- Hypoglycemia:Tremor, sweating, dizziness, hunger, irritability.
- Neuropathic: Tremor, numbness, tingling, weakness
- Panic disorder: Tremor, suffocation, chest tightness, palpitations
- Benzodiazepine withdrawal: Hand tremor, sleep disturbance, irritability, sweating, nausea, difficulty concentrating.
References
- ↑ 1.0 1.1 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.
- ↑ Crawford P, Zimmerman EE (2011). "Differentiation and diagnosis of tremor". Am Fam Physician. 83 (6): 697–702. PMID 21404980.
- ↑ Sharma S, Pandey S (2016). "Approach to a tremor patient". Ann Indian Acad Neurol. 19 (4): 433–443. doi:10.4103/0972-2327.194409. PMC 5144461. PMID 27994349.
- ↑ Bhatia KP, Bain P, Bajaj N, Elble RJ, Hallett M, Louis ED; et al. (2018). "Consensus Statement on the classification of tremors. from the task force on tremor of the International Parkinson and Movement Disorder Society". Mov Disord. 33 (1): 75–87. doi:10.1002/mds.27121. PMC 6530552 Check
|pmc=value (help). PMID 29193359. - ↑ Smaga S (2003). "Tremor". Am Fam Physician. 68 (8): 1545–52. PMID 14596441.