Tremor of hands

Introduction Parkinson's disease cannot be diagnosed with tremors alone. There are many reasons for causing tremors in both hands. We should first understand that there are many types of tremors. According to the relationship between tremor and voluntary movement, tremor can be divided into the following categories: static tremor, posture tremor, intentional tremor, and other tremors.

Cause

Resting tremor: It is a rhythmic tremor that occurs in a state of rest or muscle relaxation. The general frequency is usually 4-g times/second. It is generally slower than simple tremor, slightly larger than the frequency of action tremor. The amplitude is slightly smaller. Appeared in a static state, reduced or disappeared during exercise, and more often at the distal end of the limb. Static tremor is one of the clinical manifestations of Parkinson's disease. Static tremor of Parkinson's disease is often accompanied by increased muscle tone. During the examination, "gear-like" or "lead-tube-like" rigidity can be found, which is easy to find when the head and neck are flexed and flexed and the elbow and wrist joints are passively active. Its key reflex can be normal, without pathological reflex and sensory disturbance. The location of the tremor, the frequency and amplitude of the tremor are characteristic; whether the tremor affects the motor function depends on the severity of the tremor.

Postural tremor: It is tremor when the body actively maintains a certain posture. It is more common in the distal end of the limb. The amplitude is smaller, and the naked eye is not noticeable. Occasionally, tremors may be slightly noticeable during movement, but most are most noticeable when a certain position is fixed. Generally, the static tremor is finer and faster, and the general frequency is 8-12 times/second. There are three types of postural tremors that are common in clinical practice: 1 variability physiological tremor. It is caused by the strengthening of physiological tremor. Such as the application of adrenaline, hyperthyroidism, pheochromocytoma, hypoglycemia, emotional stress, anxiety, panic, fatigue and other tremors, also seen in cocaine, alcoholism and adverse reactions of certain drugs. It is thought to be involved in an enhanced regulatory response to adrenergic receptors. 2 familial tremor, also known as simple tremor or idiopathic tremor. It is a genetically related tremor that can occur at all ages and the magnitude of tremor varies with muscle tone. Tremor is mainly seen in the distal end of the upper extremity, involving fewer lower limbs, and the lips, lower collar, tongue, etc. can also occur. Note the differentiation from Parkinson's disease with resting tremor and action tremor caused by cerebellar lesions. 3 flapping tremors. It is caused by both basal ganglia lesions and cerebellar ataxia. This kind of tremor is relatively large, the rhythm is slow, and the symmetry affects the limbs, and the muscle tension is variable. This kind of tremor is like a bird flapping its wings, hence the name "Flapping tremor." Mainly found in hepatolenticular degeneration, hepatic encephalopathy, uremia and other metabolic encephalopathy.

Intentional tremor: Also known as action tremor. It refers to the tremor that occurs when exercising at random. It is characterized by the most obvious tremor in random or near-target, mainly in the cerebellum and its efferent pathway lesions. Intentional tremor can also be accompanied by a decrease in muscle tone, which occurs only during limb movement.

Other tremors: such as addiction tremor, most of them are action tremors, but also those with static tremors. The tremor is mostly limited to one limb or the whole body. The magnitude varies, and there is often no regularity. Most of them are relatively large and sometimes shaken. When distracting the patient's attention, the tremor is often relieved; when the tremor is concentrated, the symptoms are aggravated. There are often causes of psychogenicity or other signs of addiction.

an examination

Related inspection

EEG examination of brain CT

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. According to the clinical manifestations, a diagnosis can be made in combination with the cause type. 1 with other signs of the nervous system, or a history of trauma shortly before the occurrence of tremor. 2 Physiological hyperactivity caused by physical, anxiety, depression, hyperthyroidism, etc. 3 has a history of mental (cardiac) tremor. 4 sudden onset or segmentation progress. 5 primary erectile tremor. 6 only location-specific or target-specific tremors, including occupational tremors and primary writing tremors. 7 only speech, tongue, sputum or leg tremor.

Class I: Very slight tremor (not easy to find).

Class II: Easy to find amplitude less than 2cm without disabling tremor.

Grade III: Significant amplitude 2 to 4 cm partial disabling tremor.

Grade IV: a severe amplitude of more than 4 cm of disabling tremor.

Differential diagnosis

Mainly identified with Parkinson's disease.

(1) Parkinson's syndrome after encephalitis:

The Parkinson's syndrome caused by lethargy encephalitis has not been reported for nearly 70 years, so Parkinson's syndrome disappears after encephalitis caused by this encephalitis. In recent years, patients with viral encephalitis have been reported to have Parkinson-like symptoms, but this disease has obvious infection symptoms, which may be accompanied by symptoms of nervous system damage such as cranial nerve palsy, limb paralysis, convulsions, coma, etc. Cerebrospinal fluid may have a small number of cells ~ Increased degree, increased protein, reduced sugar, etc. After the condition is relieved, the Parkinson-like symptoms are relieved and can be differentiated from Parkinson's disease.

(2) Hepatolenticular degeneration:

Recessive hereditary diseases, about one-third of family history, adolescent onset, may have increased limb muscle tone, tremor, mask-like face, torsion and other extrapyramidal symptoms. It has characteristic features such as liver damage, corneal KF ring and serum ceruloplasmin decrease. Can be identified with Parkinson's disease.

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