Symptom finder- The causes of tremor
Symptom finder - The causes of tremor
The tremor can be divided into drugs induced tremor, action tremor, intention tremor and resting tremor.
Drug induced tremor may include ciclosporin, phenytoin, lithium, beta agonist, alcohol, caffeine, drug withdrawal ( opiates and benzodiazepines) and alcohol withdrawal.
The action tremor is due to thyrotoxicosis, chronic respiratory disease, exercise, anxiety, physiological , benign essential tremor and idiopathic. Intention tremor is caused by cerebellar disease while resting tremor is associated with Parkinson’s disease.
There are three groups of tremor such as intention tremor that present during movement, action tremor that occur as the hand is held in a sustained position against gravity and resting tremor.Exercise or anger are the precipitating causes of physiological tremor. Benign essential tremor is an action tremor that resolves as the limb is supported/hold against gravity. Benign essential tremor is worst with exercise. Family history plays a major factor in causing benign essential tremor. Beside tremor, thyrotoxicosis patient may also suffer from diarrhea,anxiety, loss of weight, increase in appetite and heat intolerance.Parkinson’s disease tremor is often subtle. In this case, other features of tremor should be excluded. These include difficulty initiating movement, slowness in movement , stopping walking, muscle fatigue ( during writing) and muscle rigidity. Balance and coordination are associated with cerebellar disease. Full history of drug intake is useful to identify any drug induced tremor. Alcohol is always considers as a common cause of tremor. Patient is observed at rest. Parkinson’s disease is suggestive by pill - rolling tremor, drooling of saliva, titubation and expressionless face.
Patient who suffer from thyrotoxicosis disorder may present with goiter, lid lag, starring eyes and exophthalmos in case of Graves’ disease.
The tremor is obvious by asking the patient to outstretched the arms. In case of fine tremor, the tremor is accentuated by placing a piece of paper on an outstretched hands. In case of benign essential tremor, full support of the arm and this will cause the resolution of the tremor. Finger- nose test is useful for detecting the present of intention tremor. In this case, the tremor is markedly increase after the finger approaches the target. Finger may also overshoot the target, past- pointing.
Further evaluation include determining the underlying causes. Observe the gait and identify the differences between ataxic gait of cerebellar disease and Parkinsonian gait. Assess for other features of cerebellar dysfunction such as pendular reflexes , nystagmus, dysdiadochokinesia and scanning speech. Palpate the thyroid gland, assess the ocular movement and auscultate the thyroid gland for bruit due to Graves’ disease. Signs of chronic liver disease may present as well as cerebellar degeneration due to excess alcohol intake.
The investigations require are arterial blood gases, liver function test, thyroid stimulating hormone, free T4, CT scan, MRI scan of the head.
Arterial blood gases may reveal carbon dioxide retention and hypoxia in respiratory disease. Abnormal liver function test may present due to impairment of synthetic liver function in chronic excess of alcohol intake. CT scan/MRI scan is useful in evaluating patient with impair co ordination due to cerebellar disease.
The tremor can be divided into drugs induced tremor, action tremor, intention tremor and resting tremor.
Drug induced tremor may include ciclosporin, phenytoin, lithium, beta agonist, alcohol, caffeine, drug withdrawal ( opiates and benzodiazepines) and alcohol withdrawal.
The action tremor is due to thyrotoxicosis, chronic respiratory disease, exercise, anxiety, physiological , benign essential tremor and idiopathic. Intention tremor is caused by cerebellar disease while resting tremor is associated with Parkinson’s disease.
There are three groups of tremor such as intention tremor that present during movement, action tremor that occur as the hand is held in a sustained position against gravity and resting tremor.Exercise or anger are the precipitating causes of physiological tremor. Benign essential tremor is an action tremor that resolves as the limb is supported/hold against gravity. Benign essential tremor is worst with exercise. Family history plays a major factor in causing benign essential tremor. Beside tremor, thyrotoxicosis patient may also suffer from diarrhea,anxiety, loss of weight, increase in appetite and heat intolerance.Parkinson’s disease tremor is often subtle. In this case, other features of tremor should be excluded. These include difficulty initiating movement, slowness in movement , stopping walking, muscle fatigue ( during writing) and muscle rigidity. Balance and coordination are associated with cerebellar disease. Full history of drug intake is useful to identify any drug induced tremor. Alcohol is always considers as a common cause of tremor. Patient is observed at rest. Parkinson’s disease is suggestive by pill - rolling tremor, drooling of saliva, titubation and expressionless face.
Patient who suffer from thyrotoxicosis disorder may present with goiter, lid lag, starring eyes and exophthalmos in case of Graves’ disease.
The tremor is obvious by asking the patient to outstretched the arms. In case of fine tremor, the tremor is accentuated by placing a piece of paper on an outstretched hands. In case of benign essential tremor, full support of the arm and this will cause the resolution of the tremor. Finger- nose test is useful for detecting the present of intention tremor. In this case, the tremor is markedly increase after the finger approaches the target. Finger may also overshoot the target, past- pointing.
Further evaluation include determining the underlying causes. Observe the gait and identify the differences between ataxic gait of cerebellar disease and Parkinsonian gait. Assess for other features of cerebellar dysfunction such as pendular reflexes , nystagmus, dysdiadochokinesia and scanning speech. Palpate the thyroid gland, assess the ocular movement and auscultate the thyroid gland for bruit due to Graves’ disease. Signs of chronic liver disease may present as well as cerebellar degeneration due to excess alcohol intake.
The investigations require are arterial blood gases, liver function test, thyroid stimulating hormone, free T4, CT scan, MRI scan of the head.
Arterial blood gases may reveal carbon dioxide retention and hypoxia in respiratory disease. Abnormal liver function test may present due to impairment of synthetic liver function in chronic excess of alcohol intake. CT scan/MRI scan is useful in evaluating patient with impair co ordination due to cerebellar disease.
