Senile tremor

Introduction Some elderly people usually tremble with their hands, and they often think that it is a normal phenomenon of old people, so they don't pay attention. In fact, it is mostly a disease of dyskinesia. Movement disorder (also known as extraditional disease) (extrapyramidaldiseases) is mainly characterized by random motor regulation dysfunction muscle strength and cerebellar function are not affected. This group of diseases stems from basal ganglia dysfunction, usually divided into increased muscle tone - decreased exercise and decreased muscle tone - excessive exercise, the two major types of the former are characterized by poor exercise, the latter mainly manifests abnormal involuntary movement.

Cause

The etiology and pathogenesis of idiopathic tremor are still unclear, but about one-third of patients have a family history, so it has a lot to do with heredity. Some elderly people think that they have tremors and suspect that they are Parkinson's disease. In fact, they are two kinds of diseases. One of the symptoms of both diseases is tremor, but tremor is the only symptom of idiopathic tremor, and Parkinson's disease has some other symptoms besides tremor. The location of the tremor is different. Parkinson's is easy to occur in the hands, lower limbs, and trunk. The essential tremor is mainly in the hands, the head, the lower jaw, the tongue, and the trunk and lower limbs are not easy to tremble. In patients with idiopathic tremor, when doing action, such as holding vegetables, the end water is easy to sprinkle. This situation is anisotropic tremor. Parkinson's disease is just the opposite. It is a tremor at rest. In severe cases, it begins to tremble as soon as it wakes up.

an examination

Related inspection

EMG electroencephalography

Blood electrolytes, trace elements and biochemical tests are helpful for the diagnosis of dyskinesia diseases, such as serum copper urinary copper and serum ceruloplasmin in patients with Wilson's disease, which has important diagnostic significance.

Differential diagnosis

The differential diagnosis of idiopathic tremor is very important, mainly identified with the following diseases.

1. Parkinson's disease: Parkinson's disease is mostly in the elderly, this period is also the multiple age of idiopathic tremor, so many idiopathic tremors are misdiagnosed as Parkinson's disease. The incidence of PD in patients with idiopathic tremor was higher than that in the general population. The study found that the tremor of relatives of PD patients was at least 2.5 times that of the normal control group, and the relatives of PD patients with essential tremors had a tremor rate of 10 times. It shows that although idiopathic tremor and PD are two independent diseases, there may be some connection between them. PD tremor is mainly static, combined with action tremor, often accompanied by slow movement, rigidity, abnormal gait and less expression.

2. Hyperthyroidism and adrenal hyperfunction: Causes hyperthyroidism tremor. When a large inertia load is applied to the limb, the frequency of tremor can be reduced by more than 1 time/s. The characteristic tremor does not have this performance, which may be accompanied by hyperesthesia, hyperhidrosis, and heart rate. Hyperthyroidism, such as speed-up, weight loss, increased neurological excitability, and goiter, accompanied by adrenal hyperactivity such as full moon face, central obesity, hypertension, and multi-blood.

3. erect tremor: performance of standing and lower limb posture tremor when standing, can involve the upper limbs, with body instability and calf sputum (muscle high-frequency tonic contraction), relieved after sitting or lying on the back, reduce when walking. Patients with familial postural tremor have a higher incidence of orthostatic tremor. Both PET have bilateral cerebellum, contralateral lenticular nucleus and thalamic dysfunction, suggesting that there may be a relationship between the two. Compared with idiopathic tremor, the frequency of orthostatic tremor (14-18 times/s) was faster, and it was significantly relieved with clonazepam (clonazepam) and gabapentin.

4. Cerebellar efferent pathway lesions: mainly cerebellar nucleus and combined arm lesions, showing upper and lower limbs intentional tremor, often accompanied by other cerebellar signs such as ataxia.

5. Poisoning or drug-induced tremor: usually with postural tremor combined with exercise tremor, static tremor and intentional tremor may also occur, depending on the type of drug and the severity of the poisoning. Most tremors involve the whole body, irregular rhythms, and flapping tremors with myoclonus.

6. Cortical tremor: irregular high frequency (>7 times / s) posture and exercise tremor, often accompanied by exercise myoclonus. Electrophysiological examination revealed significant somatosensory evoked potentials and enhanced somatosensory reflexes.

7. Red nucleus and midbrain tremor: a mixture of static, postural, and intentional tremor, with a tremor frequency of 2 to 5 times/s. Usually caused by lesions near the red nucleus (stroke or trauma), affecting one side of the nigrostriatal and binding arm pathways, leading to contralateral limb tremor, this disease is often associated with other signs of brain stem and cerebellar lesions. According to the patient's frequent posture and/or action tremor, after drinking, the family history, without other symptoms and signs of the nervous system, should consider the possibility of idiopathic tremor.

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