Recommandé
Contenu connexe
Tendances
Tendances (20)
Similaire à Tremor
Similaire à Tremor (20)
Plus de bausher willayat
Plus de bausher willayat (20)
Dernier
Dernier (20)
Tremor
- 1. Mahmood AL-Haddabi R1 Family Medicine Differentiation and Diagnosis of Tremor
- 2. Introduction Tremor is an involuntary, rhythmic, oscillatory movement of a body part. It is the most common movement disorder encountered in clinical practice. History and physical examination can provide a great deal of certainty in diagnosis
- 3. The most common tremor seen is enhanced physiologic tremor, followed by essential tremor and parkinsonian tremor. All tremors are more common in older age
- 5. ESSENTIAL TREMOR The most common pathologic tremor. In 50% of cases, transmitted as an autosomal dominant . affects 0.4 to 6 percent of the population. Careful history reveals that patients with essential tremor have it in early adulthood (or sooner).
- 6. up to 25 % of those afflicted retire early or modify their career path. Essential tremor is an action tremor, usually postural (but also kinetic and rest tremors have also been described). most obvious in the wrists and hands .
- 7. It is generally bilateral No diagnostic criteria. considered a diagnosis of exclusion. It is responds to alcohol.
- 8. PARKINSONISM clinical syndrome characterized by tremor, bradykinesia, rigidity, and postural instability . Causes of parkinsonism include: Parkinson disease . brainstem infarction. multiple system atrophy. medications that block or deplete dopamine, such as methyldopa, metoclopramide ,haloperidol, and risperidone
- 9. >70 % of patients have tremor as the presenting feature. The classic parkinsonian tremor begins as a low-frequency, pill-rolling motion of the fingers, progressing to forearm pronation/supination and elbow flexion/extension.
- 10. asymmetric, occurs at rest, and becomes less prominent with voluntary movement . Although rest tremor is one of the diagnostic criteria for Parkinson disease, most patients exhibit a combination of action and rest tremors.
- 11. ENHANCED PHYSIOLOGIC TREMOR present in all persons . low-amplitude, high-frequency tremor at rest and during action. enhanced by anxiety, stress, and certain medications and metabolic conditions. do not need further testing
- 13. CEREBELLAR TREMOR presents as a disabling, low-frequency, slow intention or postural tremor . caused by multiple sclerosis with cerebellar plaques, stroke, or brainstem tumors . neurologic signs : dysmetria dyssynergia. hypotonia
- 15. DYSTONIC TREMOR rare tremor found in 0.03 % of the population. typically occurs in patients younger than 50 years. usually irregular and jerky, and certain hand or arm positions will extinguish the tremor.
- 16. WILSON DISEASE rare, autosomal recessive disorder. manifests in persons five to 40 years of age . sometimes with a “wing-beating” tremor Serum ceruloplasmin level and 24-hour urinary copper excretion
- 17. Diagnostic Approach thorough history and physical examination. have the patients sit with their hands in their laps, then stretch arm and examine for cerebellar signs
- 18. categorize the tremor based on its activation condition, topographic distribution, and frequency . Frequency is generally classified as low (less than 4 Hz), medium (4 to 7 Hz), or high (more than 7 Hz)
Notes de l'éditeur
- Seen at primary health care
- Tremors are classified as either resting or action (Table 1).8 A rest tremor occurs in a body part that is relaxed and completely supported against gravity (e.g., when resting an arm on a chair). It is typically enhanced by mental stress (e.g., counting backward) or movement of another body part (e.g., walking), and diminished by voluntary movement of the affected body part.3,9,10 Most tremors are action tremors, which occur with voluntary contraction of a muscle. Action tremors can be further subdivided into postural, isometric, and kinetic tremors.8,9 A postural tremor is present while maintaining a position against gravity. An isometric tremor occurs with muscle contraction against a rigid stationary object (e.g., when making a fist). A kinetic tremor is associated with any voluntary movement and includes intention tremor, which is produced with target-directed movement.
- Careful history reveals that patients with essential tremor have it in early adulthood (or sooner), but most patients do not seek help for it until 70 years of age because of its progressive nature.
- most obvious in the wrists and hands when patients hold their arms in front of themselves (resisting gravity); however, essential tremor can also affect the head, lower extremities, and voice
- Persons with essential tremor typically have no other neurologic findings; therefore, it is often considered a diagnosis of exclusion
- Parkinsonism is a clinical syndrome characterized by tremor, bradykinesia, rigidity, and postural instability. Many patients will also have micrographia, shuffling gait, masked facies, and an abnormal heel-to-toe test. Parkinson disease is a chronic neurodegenerative disorder
- those that stimulate the sympathetic nervous system (e.g., amphetamines, terbutaline, pseudoephedrine) and psychoactive medications (e.g., tricyclic antidepressants, haloperidol, fluoxetine [Prozac]).1,8,12 When medication review reveals a likely culprit, a trial off of this medication should be attempted. Metabolic causes of tremor are varied.8 Initial workup of tremor may include blood testing for hepatic encephalopathy, hypocalcemia, hypoglycemia, hyponatremia, hypomagnesemia, hyperthyroidism, hyperparathyroidism, and vitamin B12 deficiency.8
- dysmetria (overshoot on finger-to-nose testing). -dyssynergia (abnormal heel-to-shin testing and/or atraxia).
- For example, a high-frequency tremor that involves the head is much more likely to be essential tremor than parkinsonian tremor
- A search must be made for associated diseases (e.g., sleep disorders because fatigued muscles may amplify physiologic tremor; polyneuropathy because lack of innervations may cause small involuntary movements that are interpreted as tremor). A family history of neurologic disease or tremor suggests a genetic component, as is often seen in essential tremor. A thorough medication history should be obtained to rule out drug-induced tremor. The patient should also be screened for drugs of abuse and alcohol consumption because alcohol overuse and withdrawal can cause tremor