Tremor differential diagnosis: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Tremor}} | {{Tremor}} | ||
{{CMG}}; {{AE}} {{ZMalik}} | |||
==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== | |||
*Tremor must be differentiated from diseases that cause involuntary movement: <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> | |||
**[[Myoclonus]]: Brief [[muscle]] twitches, limited to single [[limb]] or to adjacent parts.[[EEG]] shows association with spike-wave complexes. | |||
**[[Clonus]]: Rhythmic movement aggravated by [[muscle]] stretching. | |||
**[[Asterixis]]: On [[electromyographic]], flapping/abduction of the [[upper extremities]] is indicated as prolong absence of [[EMG]] activity. | |||
**[[Epilepsia partialis continua]]: Regular jerks of the arm/hand. | |||
*Differentiating the cause of tremor from other [[diseases]] on the basis of the type of tremor, associated [[signs]], and [[symptoms]].<ref name="pmid19750493">{{cite journal| author=Deuschl G, Elble R| title=Essential tremor--neurodegenerative or nondegenerative disease towards a working definition of ET. | journal=Mov Disord | year= 2009 | volume= 24 | issue= 14 | pages= 2033-41 | pmid=19750493 | doi=10.1002/mds.22755 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19750493 }} </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><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> | |||
{| class="wikitable" | |||
!align="center" style="background: #4479BA; color: #FFFFFF | '''Common Cause of Tremor''' | |||
! align="center" style="background: #4479BA; color: #FFFFFF| '''Differentiating Feature of Tremor''' | |||
! align="center" style="background: #4479BA; color: #FFFFFF| '''Main Feature of Disease''' | |||
|- | |||
| [[Essential tremor]] || Postural Tremor - [[Frequency]] 4–12 Hz, Bilateral onset || [[gait]] [[ataxia]], [[vestibulo-cerebellar]] 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]] 8–10 Hz, low [[amplitude]], irregular oscillations || Tremor occurs while maintaining a posture and mostly disappears if [[eyes]] are closed or a load is placed on the [[muscles]]. Subtle [[innate]] tremor normally present in the general [[population]]. | |||
|- | |||
| Enhanced [[Physiologic]] Tremor ||Increased [[amplitude]] ||[[Physiologic]] tremor enhanced due to [[fatigue]], [[sleep deprivation]], [[drugs]], [[endocrine disorders]], [[caffeine]], [[stress]]. | |||
|- | |||
| [[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 | |||
|- | |||
|Holmes tremor || Combination of rest, action, and postural tremors, [[Frequency]] 2Hz-5Hz || Mostly due to [[vascular]] [[lesion]] in [[mesencephalic]], [[thalamic]] or both regions. | |||
|} | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category: | |||
[[Category:Neurology]] | |||
[[Category:Primary care]] | |||
[[Category:Signs and symptoms]] | |||
[[Category:Medicine]] | |||
Latest revision as of 20:38, 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 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
- Tremor must be differentiated from diseases that cause involuntary movement: [1]
- Myoclonus: Brief muscle twitches, limited to single limb or to adjacent parts.EEG shows association with spike-wave complexes.
- Clonus: Rhythmic movement aggravated by muscle stretching.
- Asterixis: On electromyographic, flapping/abduction of the upper extremities is indicated as prolong absence of EMG activity.
- Epilepsia partialis continua: Regular jerks of the arm/hand.
- Differentiating the cause of tremor from other diseases on the basis of the type of tremor, associated signs, and symptoms.[2][3][4]
| Common Cause of Tremor | Differentiating Feature of Tremor | Main Feature of Disease |
|---|---|---|
| Essential tremor | Postural Tremor - Frequency 4–12 Hz, Bilateral onset | gait ataxia, vestibulo-cerebellar 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 8–10 Hz, low amplitude, irregular oscillations | Tremor occurs while maintaining a posture and mostly disappears if eyes are closed or a load is placed on the muscles. Subtle innate tremor normally present in the general population. |
| Enhanced Physiologic Tremor | Increased amplitude | Physiologic tremor enhanced due to fatigue, sleep deprivation, drugs, endocrine disorders, caffeine, stress. |
| 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 |
| Holmes tremor | Combination of rest, action, and postural tremors, Frequency 2Hz-5Hz | Mostly due to vascular lesion in mesencephalic, thalamic or both regions. |
References
- ↑ 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.
- ↑ 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.
- ↑ Smaga S (2003). "Tremor". Am Fam Physician. 68 (8): 1545–52. PMID 14596441.
- ↑ Crawford P, Zimmerman EE (2011). "Differentiation and diagnosis of tremor". Am Fam Physician. 83 (6): 697–702. PMID 21404980.