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{{Tremor}}
{{Tremor}}
{{CMG}};{{AE}} [[User:Naresh Mullaguri|Naresh Mullaguri, M.B.B.S.]] [mailto:mullaguri.nari@gmail.com]
{{CMG}};{{AE}} {{ZMalik}}
==Overview==
Common causes of tremor in primary care include enhanced [[physiologic tremor]], [[essential tremor]], and [[Parkinson’s disease]].
 
==Causes==
==Causes==
Tremor is generally caused by problems in parts of the brain or spinal cord that control muscles throughout the body or in particular areas, such as the hands. Neurological disorders or conditions that can produce tremor include [[multiple sclerosis]], [[stroke]], [[traumatic brain injury]] and [[neurodegenerative disease]]s that damage or destroy parts of the [[brainstem]] or the [[cerebellum]]. Other causes include the use of some drugs (such as [[amphetamine]]s, [[caffeine]], [[corticosteroid]]s, and drugs used for certain psychiatric disorders), alcohol abuse or withdrawal, [[mercury poisoning]], overactive [[thyroid]] or [[liver failure]]. Tremors can be an indication of [[hypoglycemia]], along with palpitations, sweating and anxiety. <!-- Biochemistry 3rd ed. Lippinscott illustrated reviews. Champe, Harvey, Ferrier. 2005 (for the last sentence) -->
Tremor can also be caused from lack of [[sleep]], [[vitamin]]s, or having too much [[stress]].
Deficiencies of magnesium and [[vitamin B1]] have also been known to cause tremor or shaking which resolves when the deficiency is corrected. See [[magnesium in biology]].
Some forms of tremor are inherited and run in families, while others have no known cause. Tremors can also be caused by some spider bites i.e. the redback spider of Australia.
Tremor can result from other conditions as well. [[Alcoholism]], excessive alcohol consumption, or alcohol withdrawal can kill certain nerve cells, resulting a tremor known as [[asterixis]]. Conversely, small amounts of alcohol may help to decrease familial and essential tremor, but the mechanism behind this is unknown. Tremor in [[peripheral neuropathy]] may occur when the nerves that supply the body’s muscles are traumatized by injury, disease, abnormality in the central nervous system, or as the result of systemic illnesses. Peripheral neuropathy can affect the whole body or certain areas, such as the hands, and may be progressive. Resulting sensory loss may be seen as a tremor or ataxia (inability to coordinate voluntary muscle movement) of the affected limbs and problems with gait and balance. Clinical characteristics may be similar to those seen in patients with essential tremor.
=== Common Causes===
=== Causes by Organ systems===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" |
|-
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|bgcolor="Beige"| 2,4-Dichlorophenol, 3-Aminopyridine, [[4-Aminopyridine]], Acetylene Dichloride, Acidic dry cell batteries, [[Acrylamide]], Agrocide, Agronexit, [[Amidithion]],[[Amiton]], Aparasin, Aphtiria, [[Athyl-Gusathion]], [[Azinfos-methyl]], [[Azinfosethyl]], [[Azinophos-methyl]], [[Azinphos]], [[Azinphos-ethyl]],[[Azinphos-methyl]], [[Azinphosmetile]], [[Azothoate]], Ben-Hex, Benhexol, [[Benoxafos]], Bexol, [[Biphenyl]], [[Bromide]], [[Bromoform]], [[Bromophos]], [[Bromophos-ethyl]], [[Cadusafos]], [[Carbinoxamine]], [[Carbon Disulfide]], [[Carbon Tetrachloride]], [[Carbophenothion]], [[Chlordane]], Chlordecone,  Chloresene, [[Chlorfenvinphos]], [[Chloromethane]], [[Chloropyrifos]], [[Chlorpyrifos methyl]], [[Cresols]], [[Cresylic acid]], [[Cyanthoate]],d-Phenothrin, [[DDD]], [[DDT]], [[Demeton]], [[Demeton-methyl]], [[Demeton-O]], [[Demeton-O-methyl]], [[Demeton-S-methyl]], [[Demeton-S-methylsulphon]], [[Dialifos]], [[Diazinon]], [[Diborane]], [[Dichlorvos]], [[Dimethoate]], [[Dioxathion]], Diquat Dibromide, [[Disulfiram]][[Disulfoton]], [[Endosulfan]], [[Endothion]], [[Epichlorohydrin]], [[Ethion]], [[Ethoate-methyl]], [[Ethoprophos]], Ethyl Mercaptan, [[Ethyl-guthion]], [[Ethylbenzene]], [[Ethylene Dichloride]], [[Etrimfos]], [[Fenchlorphos]], [[Fenitrothion]], [[Fensulfothion]], [[Fenthion]], [[Fipronil]], Fluoridated toothpaste, [[Fonophos]], [[Formothion]], [[Gasoline]], [[Glaze]], [[Glufosinate]], [[Glycol Ether]], [[Guthion (ethyl)]], [[Heptachlor]], [[Heptenophos]], [[Iodofenphos]], [[Lindane]], [[Malathion]], [[Manganese]], [[Mecarbam]], [[Metaldehyde]], [[Methacrifos]], [[Methamidophos]], [[Methidathion]], [[Methylene Chloride]], [[Metiltriazotion]], [[Mevinphos]], [[Monocrotophos]], Monosodium Methanarsenate, [[Omethoate]], [[Oxydeprofos]], [[Oxydisulfoton]], [[Parathion]], [[Parathion Methyl]], [[Phenkapton]], [[Phenol]], [[Phorate]], [[Phosalone]], [[Phosmet]], [[Phosphamidon]], [[Phosphine]], [[Phoxim]], [[Pirimiphos-methyl]], [[Primiphos methyl]], [[Prothidathion]], [[Prothoate]], [[Pyrethrin]], [[Pyrimitate]], [[Quinalphos]], [[Quintiofos]], [[RDX]], [[Rotenone]], [[Sophamide]], [[Sulfotep]], [[Sulfuryl Fluoride]], [[Terbufos]], [[Tetrachloroethane]], [[Thallium]], [[Thallium Sulfate]], [[Thiometon]], [[Tolclofos methyl]], [[Toxaphene]], [[Triazophos]], [[Triazotion]], [[Trichloroethylene]], [[Trifenfos]], [[Vamidothion]]
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"|
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"|
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| [[Adrenal adenoma]], [[Adrenal cancer ]], [[Adrenal incidentaloma ]], Adrenal medulla neoplasm, [[Diabetes insipidus]], [[diabetes mellitus]], High T4 syndrome, [[Hyperadrenalism ]], [[Hyperthyroidism]], [[Toxic multinodular goiter]], [[Pheochromocytoma ]], [[Pituitary tumors]]
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"|
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"|
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"|
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"|
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"|
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"|
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"|
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"|
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"|
|-
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"|
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"|
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"|
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"|
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"|
|-
|}
=== Causes by Alphabetical order ===
{{MultiCol}}
*2,4-Dichlorophenol
*3-Aminopyridine
*[[4-Aminopyridine ]]
*Acetylene dichloride
*Acidic dry cell batteries inhalation  poisoning
*[[Acrylamide]]
*[[xylene]]
*[[Adrenal adenoma]],familial
*[[Adrenal cancer ]]
*[[Adrenal incidentaloma ]]
*Adrenal medulla neoplasm
*Agrocide
*Agronexit
*[[Alcohol withdrawal syndrome]]
*[[Alcohol]]
*Alcoholic cerebellar degeneration
*[[Alcohol intoxication]]
*Alcohol-induced disorders
*[[Alzheimer's disease]]
*[[Amidithion ]]
*[[Amiodarone]]
*Amish nemaline myopathy
*[[Amiton ]]
*Amphetamine abuse
*[[Amyloidosis, oculoleptomeningeal ]]
*Aniridia cerebellar ataxia mental  deficiency
*[[Anxiety]]
*Aparasin
*Aphtiria
*[[Arginase deficiency ]]
*[[Arsenic poisoning]]
*[[Athyl-Gusathion]]
*[[Azinfosethyl ]]
*[[Azinfos-methyl ]]
*[[Azinophos-methyl ]]
*[[Azinphos ]]
*[[Azinphos-ethyl ]]
*[[Azinphos-methyl ]]
*[[Azinphosmetile ]]
*[[Azothoate ]]
*Basal ganglia calcification,  idiopathic 1
*Ben-Hex
*Benhexol
*[[Benign essential tremor syndrome ]]
*Benign [[essential tremor]]
*[[Benoxafos ]]
*Bexol
*[[Biphenyl ]]
*[[Black Cohosh]] overdose
*[[Bovine spongiform encephalopathy ]]
*Brain Fag syndrome
*[[Bromide ]]
*[[Bromoform ]]
*[[Bromophos ]]
*[[Bromophos-ethyl ]]
*[[Cadusafos ]]
*Caffeine overdose
*Calcification of basal ganglia with or  without hypocalcemia
*[[Carbamate insecticide poisoning ]]
*[[Carbinoxamine ]]
*[[Carbon disulfide ]]
*[[Carbon tetrachloride ]]
*[[Carbophenothion ]]
*Central nervous system protozoal  infections
*Cerebellar degeneration
*Cerebellar disease
*[[Cerebrovascular accident]]
*[[Ceroid lipofuscinosis]], neuronal 6,  late infantile
*[[Chediak-Higashi disease]]
*[[Chlordane ]]
*Chlordecone
*Chloresene
*[[Chlorfenvinphos ]]
*[[Chloromethane ]]
{{ColBreak}}
*[[Chloropyrifos ]]
*[[Chlorpyrifos methyl]]
*Chromosome 20p, partial duplication
*[[Cirrhosis of liver]]
*[[Cockayne syndrome ]]
*Combarros Calleja Leno syndrome
*[[Cresols ]]
*[[Cresylic acid ]]
*[[Creutzfeldt-Jakob disease ]]
*[[Cyanthoate ]]
*[[Cyclosporin]]
*[[Da Costa's syndrome]]
*[[DDD ]]
*[[DDT ]]
*[[Dementia With Lewy Bodies]]
*[[Demeton ]]
*[[Demeton-methyl ]]
*[[Demeton-O ]]
*[[Demeton-O-methyl ]]
*[[Demeton-S-methyl ]]
*[[Demeton-S-methylsulphon ]]
*[[Dexedrine overdose]]
*[[Diabetes insipidus]], [[diabetes mellitus]],[[optic atrophy]]
*[[Dialifos ]]
*[[Diazinon ]]
*[[Diborane ]]
*[[Dichlorvos ]]
*Diencephalic Syndrome
*[[Dimethoate ]]
*[[Dioxathion ]]
*Diquat dibromide
*Discontinuation syndrome
*[[Disulfiram ]]
*[[Disulfoton ]]
*[[Dobutamine]]
*[[Dopamine]]
*[[Dopexamine]]
*[[d-Phenothrin ]]
*[[Drug withdrawal]]
*[[Drug-induced parkinsonism]]
*[[Drug-induced tremor]]
*Dystonia Musculorum Deformans 1
*[[Dystonia]]
*[[Endosulfan ]]
*[[Endothion ]]
*[[Ephedrine]]
*[[Epichlorohydrin ]]
*[[Epinephrine]]


===Common Causes===
Common [[causes]] include: <ref name="pmid21321834">{{cite journal| author=Puschmann A, Wszolek ZK| title=Diagnosis and treatment of common forms of tremor. | journal=Semin Neurol | year= 2011 | volume= 31 | issue= 1 | pages= 65-77 | pmid=21321834 | doi=10.1055/s-0031-1271312 | pmc=3907068 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21321834  }} </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>
*Enhanced [[physiologic tremor]]
*[[Essential tremor]]
*[[Essential tremor]]
 
*[[Parkinson’s disease]]  
*[[Ethion ]]
*Excessive [[caffeine]]
 
*[[Psychogenic]] due to [[stress]],[[anxiety]], and [[depression]]
*[[Ethoate-methyl ]]
*[[Hypoglycemia]]
 
*[[Fatigue]]
*[[Ethoprophos ]]
*[[Aging]]
 
===Less Common Causes===
*Ethyl Mercaptan
Less common cause include:<ref name="EliasShah2014">{{cite journal|last1=Elias|first1=W. Jeffrey|last2=Shah|first2=Binit B.|title=Tremor|journal=JAMA|volume=311|issue=9|year=2014|pages=948|issn=0098-7484|doi=10.1001/jama.2014.1397}}</ref>
 
*[[Wilson's disease]]
*[[Ethylbenzene ]]
*[[Multiple sclerosis]]
 
*[[Alcohol]] [[withdrawal]] tremor
*[[Ethylene dichloride ]]
 
*[[Ethyl-guthion ]]
 
*[[Etrimfos ]]
 
*[[Fatal familial insomnia ]]
 
*[[Fenchlorphos ]]
 
*[[Fenitrothion ]]
 
*[[Fensulfothion ]]
 
*[[Fenthion ]]
 
*[[Fipronil ]]
 
*Fluoridated toothpaste
 
*[[Fonophos ]]
 
*Food Additive Adverse reaction- MSG, Salicylate, Sulfite
 
*[[Formothion ]]
 
*[[Friedreich ataxia ]]
 
*[[Frontotemporal dementia ]]
 
*[[Fucosidosis ]]
 
*[[Gasoline ]]
 
*[[Glaze ]]
 
*[[Glufosinate ]]
 
*[[Glycol Ether]]
{{ColBreak}}
*[[Guthion (ethyl)]]
 
*[[Haloperidol]]
 
*[[Hepatic failure]]
 
*[[Heptachlor ]]
 
*[[Heptenophos ]]
 
*High T4 syndrome
 
*[[Holocarboxylase synthetase deficiency  ]]
 
*[[Huntington's disease ]]
 
*[[Hyperadrenalism ]]
 
*[[Hyperthyroidism]]
*[[Hyperthyroidism]]
 
*[[Mercury]] [[poisoning]]
*[[Hypoglycaemia]]
*[[Liver]] or [[kidney failure]]
 
*[[Drug]] Induced Tremors
*[[Hypomagnesemia]]
*[[Orthostatic]] tremor
 
*[[Hypothermia]]
 
*[[Hysteria]]
 
*Idiopathic dystonia DYT1
 
*[[Iodofenphos ]]
 
*[[Isoprenaline]]
 
*[[Kennedy's disease]]
 
*[[Krabbe leukodystrophy ]]
 
*[[Lead]]
 
*Leukoencephalopathy -- metaphyseal  chondrodysplasia
 
*Lhermitte-McAlpine syndrome
 
*[[Lidocaine]]
 
*[[Lindane ]]
 
*Lindsay-Burn syndrome
 
*[[Lithium toxicity]]
 
*[[Liver failure]]
 
*Lobelia poisoning
 
*[[Malathion ]]
 
*[[Manganese ]]
 
*Margosa oil overdose
 
*[[Mecarbam ]]
 
*[[Meningoencephalitis]]
 
*Mental retardation, X-linked, Cabezas  type
 
*[[Mercury poisoning ]]
 
*[[Mercury]]
 
*Mescal poisoning  
 
*[[Metabolic encephalopathy ]]
 
*[[Metachromatic leukodystrophy ]]
 
*[[Metaldehyde ]]
 
*[[Metaraminol]]
 
*[[Methacrifos ]]
 
*[[Methamidophos ]]
 
*[[Methamphetamine overdose ]]
 
*[[Methidathion ]]
 
*[[Methoxamine]]
 
*[[Methylene chloride ]]
 
*Methylmalonic acidemia with [[homocystinuria]]
 
*[[Metiltriazotion ]]
 
*[[Mevinphos ]]
 
*[[Minamata disease ]]
 
*[[Monocrotophos ]]
 
*Monosodium Methanarsenate
 
*Motor and cognitive disorder due to  sepiapterin reductase deficiency
 
*[[Mucolipidosis]] type 1
 
*[[Multiple sclerosis ]]
 
*[[Multiple system atrophy]]
 
*[[Myoclonic epilepsy]] benign, adult, familial
 
*[[Neuroleptic malignant syndrome]]
 
*Neuronal intranuclear inclusion  disease
 
*[[Neurosyphilis]]
 
*[[Nicotine poisoning ]]
 
*[[Norepinephrine]]
 
*Normokalemic [[periodic paralysis ]]
 
*[[Olivopontocerebellar atrophy ]]
 
*[[Omethoate ]]
 
*Oppenheim's dystonia
 
*[[Optic atrophy]]
 
*[[Organophosphate insecticide poisoning]]
 
*[[Oxydeprofos ]]
 
*[[Oxydisulfoton ]]
 
*Pallidopyramidal syndrome
 
*[[Parathion ]]
{{ColBreak}}
*[[Parathion methyl ]]
 
*[[Parkinson's disease]]
 
*[[Parkinsonism]]
 
*Pathologic tremor
 
*[[Pelizaeus-Merzbacher Disease ]]
 
*[[Peppermint]]  Oil overdose
 
*[[Phenkapton ]]
 
*[[Phenol ]]
 
*[[Phenylephrine]]
 
*[[Pheochromocytoma ]]
 
*[[Phorate ]]
 
*[[Phosalone ]]
 
*[[Phosmet ]]
 
*[[Phosphamidon ]]
 
*[[Phosphine ]]
 
*[[Phoxim]]
 
*Physiologic tremor
 
*[[Pick's disease of the brain ]]
 
*[[Pirimiphos-methyl]]
 
*[[Pituitary tumor]], adult
 
*Primary orthostatic tremor
 
*[[Primiphos methyl]]
 
*[[Prothidathion]]
 
*[[Prothoate ]]
 
*Psychogenic Movement Disorders
 
*[[Purine nucleoside phosphorylase  deficiency ]]
 
*[[Pyrethrin]]
 
*[[Pyrimitate]]
 
*[[Quinalphos]]
 
*[[Quintiofos]]
 
*[[Ramsay Hunt syndrome]]
 
*[[RDX ]]
 
*[[Reproterol]]
 
*[[Respiratory failure]]
 
*[[Rotenone ]]
 
*Roussy-Levy syndrome
 
*Sabah vegetable overdose
 
*[[Salbutamol]]
 
*Salvioli syndrome
 
*Sea Hare poisoning
 
*Selenium poisoning
 
*[[Senile]]
 
*[[Serotonin syndrome ]]
 
*[[Shy-Drager syndrome]]
 
*[[Sialidosis]]
 
*[[Sleeping sickness (East African)]]
 
*[[Sleeping sickness (West African)]]
 
*[[Sophamide ]]
 
*Spastic paraparesis deafness
 
*[[Spinocerebellar ataxia]]
 
*[[Sulfotep ]]
 
*[[Sulfuryl fluoride ]]
 
*[[Tacrolimus]]
 
*[[Terbufos ]]
 
*[[Tetrachloroethane]]
 
*[[Thallium ]]
 
*[[Thallium sulfate ]]
 
*[[Thiometon ]]
 
*[[Tolclofos methyl]]
 
*[[Toxaphene]]
 
*[[Toxic multinodular goiter]]
 
*[[Toxoplasmosis ]]
 
*[[Triazophos]]
 
*[[Triazotion ]]
 
*[[Trichloroethylene ]]
 
*[[Trifenfos ]]
 
*[[Trifluperidol]]
 
*Tubatoxin poisoning
 
*[[Uraemia]]
 
*[[Ureterosigmoidostomy]]
 
*[[Valproic acid]]
 
*[[Vamidothion]]
 
*[[Wilson's disease ]]
 
*[[Wolfram syndrome]]
 
*[[Xamoterol]]
{{EndMultiCol}}


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
[[Category:Needs content]]
[[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

Common causes of tremor in primary care include enhanced physiologic tremor, essential tremor, and Parkinson’s disease.

Causes

Common Causes

Common causes include: [1][2]

Less Common Causes

Less common cause include:[3]

References

  1. Puschmann A, Wszolek ZK (2011). "Diagnosis and treatment of common forms of tremor". Semin Neurol. 31 (1): 65–77. doi:10.1055/s-0031-1271312. PMC 3907068. PMID 21321834.
  2. Smaga S (2003). "Tremor". Am Fam Physician. 68 (8): 1545–52. PMID 14596441.
  3. Elias, W. Jeffrey; Shah, Binit B. (2014). "Tremor". JAMA. 311 (9): 948. doi:10.1001/jama.2014.1397. ISSN 0098-7484.