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Symptoms and Signs – Differential Diagnosis of Essential Tremor
• Wilson’s disease: wing-beating tremor that is most pronounced with shoulders abducted, elbows flexed, and fingers pointing toward each other. There are usually other neurologic abnormalities, including dysarthria, dystonia, and Kayser- Fleischer rings on ophthalmologic examination.
• Parkinson’s disease: tremor is usually asymmetric, especially early in the disease, and it is predominantly a resting tremor. Patients with Parkinson’s disease will also have increased tone, decreased facial expression, slowness of movement, and shuffling gait.
• Drug induced: many drugs enhance normal, physiologic tremor. These include caffeine, nicotine, lithium, levothyroxine, β- adrenergic bronchodilators, valproate, and selective serotonin reuptake inhibitors (SSRIs).
• Cerebellar tremor: an intention tremor that increases at the end of a goal-directed movement (such as finger to nose testing). Other associated neurologic abnormalities include ataxia, dysarthria, and difficulty with tandem gait.
• Wilson’s disease: wing-beating tremor that is most pronounced with shoulders abducted, elbows flexed, and fingers pointing toward each other. There are usually other neurologic abnormalities, including dysarthria, dystonia, and Kayser- Fleischer rings on ophthalmologic examination.
• Parkinson’s disease: tremor is usually asymmetric, especially early in the disease, and it is predominantly a resting tremor. Patients with Parkinson’s disease will also have increased tone, decreased facial expression, slowness of movement, and shuffling gait.
• Drug induced: many drugs enhance normal, physiologic tremor. These include caffeine, nicotine, lithium, levothyroxine, β- adrenergic bronchodilators, valproate, and selective serotonin reuptake inhibitors (SSRIs).
• Cerebellar tremor: an intention tremor that increases at the end of a goal-directed movement (such as finger to nose testing). Other associated neurologic abnormalities include ataxia, dysarthria, and difficulty with tandem gait.
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