Tremor resident survival guide

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Usman Ali Akbar, M.B.B.S.[2]

Synonyms and keywords:

Tremors resident survival guide Microchapters
Overview
Causes
FIRE
Diagnosis
Treatment
Do's
Don'ts

Overview

This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease.

Causes

Postural Tremors Resting Tremors Intention Tremors Complex Tremors
Postural tremor occurs when the patient maintains a specific posture such as holding the arms outstretched or while standing. Rest tremor presents as the affected body part fully supported against gravity. It occurs at rest and can be abolished during voluntary activity. characterized by a crescendo increase in tremor as the affected body part approaches its target
Alcohol & drug withdrawl Drug-induced parkinsonism Holmes' tremor (midbrain, red nucleus, rubral, or thalamic tremor)


Metabolic causes
  • Parkinson disease
  • Parkinsonian syndromes
  • Midbrain (rubral) tremor
  • Wilson disease
  • Severe essential tremor
Parkinson's disease Cerebellar lesions:
  • Friedreich's ataxia
  • Hemorrhage
  • Multiple sclerosis
  • Spinocerebellar degeneration
  • Stroke
  • Tumor
Neuropathic tremor:

•Chronic relapsing polyneuropathy

•Guillain-Barré syndrome

•Diabetes

•IgM neuropathy

Essential Tremors: Essential tremor Progressively persistent coarse or fine, slow (4–8 Hz) tremor, usually symmetric and affecting both upper extremities and sometimes the head and voice, particularly in patients with a family history of tremor Progressive supranuclear palsy Drug-induced Psychogenic tremor

Wilson's disease

Physiological Tremor :Fine, rapid (8–13 Hz) tremor that occurs in otherwise healthy people and may be enhanced by certain drugs or conditions

Usually, suppression of tremor with low doses of alcohol and other sedatives

FIRE: Focused Initial Rapid Evaluation

 
 
 
Paitent presenting with new-onset tremors
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Is the tremor physiological in nature?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Rule out anxiety, Excessive Caffine intake,blood glucose level,thyroid function tests
 
 
 
Medication Associated Tremor?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Trial off medication
 
 
 
Relieved by distraction?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Psychiatric Evaluation
 
 
 
Rule out Organic Cause

Diagnosis

Shown below is an algorithm summarizing the diagnosis of [[disease name]] according the the [...] guidelines.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Treatment

Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Do's

  • The content in this section is in bullet points.

Don'ts

  • The content in this section is in bullet points.

References

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