Once these are ruled out, determine whether the tremor is isolated or accompanied by other neurologic abnormalities.īecause parkinsonism is the most common syndrome accompanying tremor, assess for the presence or absence of facial masking, decreased blink rate, appendicular bradykinesia and cogwheeling, shortening of stride length, stooped posture, and impairment in postural reflexes. Several hyperkinetic movement disorders can mimic tremor, including action myoclonus and dystonia of the upper limbs. Document any family history of tremor or other neurologic complaints in parents, siblings, and children. Obtain a detailed history of drug exposure, current medications, and interventions that improve tremor (eg, alcohol ingestion). Ask about the time course, acuity of onset, progression, and specific triggers of the tremor. What are the phenomenologic features of the tremor?Ī meticulous history and examination are indispensable in answering these questions. Is the tremor isolated, or are there accompanying neurologic abnormalities?ģ. Is the movement disorder actually tremor?Ģ. The history and examination of the patient with tremor should focus on 3 practical questions:ġ. Tremor is a regular, hyperkinetic movement in which a body part oscillates to and fro around an axis.
SHAKE WITH FAST TREMULOUS MOVEMENTS SERIES
Using a series of 3 questions focusing on history and phenomenology, we demonstrate a practical approach to patients with tremor in the outpatient setting. 1 Most internists and all neurologists will encounter patients with tremor in their practice. Tremor is the most common movement disorder in adults.
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