Postural tremor

Introduction The tremor that occurs when the limb maintains a certain position is called orthostatic tremor. The most common is when the upper limb is stretched. The tremor is often suppressed during active exercise, and is strengthened when the emotion is tense. It disappears when resting completely and sleeping. Postural tremor is a clinical manifestation of Parkinson's disease. Parkinson's syndrome is a commonly used diagnostic concept for clinical neurologists. It refers to a variety of causes (cerebrovascular disease, cerebral arteriosclerosis, infection, poisoning, trauma, drugs, and genetic degeneration). Group clinical syndrome, mainly manifested as tremor, muscle stiffness, bradykinesia and posture instability.

Cause

Cause: Postural tremor is a clinical manifestation of Parkinson's disease. The exact cause of Parkinson's disease is still unknown. Genetic factors, environmental factors, ageing, oxidative stress, etc. may all be involved in the degenerative death process of PD dopaminergic neurons. The incidence and prevalence of aged aging PD increased with age. PD is more than 60 years old, which suggests that aging is related to the disease. The data show that with age, the substantia nigra dopaminergic neurons in the brain of normal adults will gradually decrease. However, the prevalence of PD in elderly people over 65 years old is not high. Therefore, age aging is only one of the risk factors for PD.

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Neurological examination electromyogram

Diagnosis: The main symptoms of Parkinson's patients are:

1 tremor: often starts from one hand, producing 4~6 times of involuntary shaking per second, and can later extend to the lower limbs of the same side and the upper and lower limbs of the opposite side. Tremors occur at rest, exacerbate when emotionally excited, and disappear when sleeping.

2 Tonic: Because of the high muscle tension, one or both limbs are hard and inflexible. Later, it can affect the trunk muscles, and it is a "small step" when walking.

3 Movement reduction: all movements are slow and reduced, and the patient is often expressionless and can't sit still.

Differential diagnosis

Differential diagnosis: mainly differentiated from Parkinson's syndrome and idiopathic tremor, benign tremor.

(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.

(3) Essential tremor:

Is a dominant genetic disease, manifested as head, jaw, limb involuntary tremor, tremor frequency can be high or low, high frequency is similar to hyperthyroidism; low frequency is similar to Parkinson's tremor. The disease has no reduction in exercise, increased muscle tone, and posture reflex disorder, and disappears after drinking, and the treatment of cardiotonic treatment can be differentiated from primary Parkinson's disease.

(4) Progressive supranuclear palsy:

The disease is also common in middle-aged and elderly people, and the clinical symptoms may include extrapyramidal symptoms such as muscle rigidity and tremor. However, this disease has prominent eye gaze disturbance, muscle rigidity is heavy on the trunk, limb muscle involvement is light, and the flexibility of the limb is maintained, the neck extensor tension is increased, and the neck overextension and Parkinson's disease neck flexion are apparent. Different, can be identified with Parkinson's disease.

(5) Shy_Drager syndrome:

Clinically, there are often extrapyramidal symptoms, but because of prominent autonomic symptoms, such as: syncope, orthostatic hypotension, sexual function and bladder dysfunction, levodopa preparations are ineffective, and can be differentiated from Parkinson's disease.

(6) Drug-induced Parkinson's syndrome:

Excessive use of reserpine, chlorpromazine, haloperidol and other antidepressants can cause extrapyramidal symptoms, due to a significant history of medication, and can be identified after withdrawal.

(7) Benign tremor:

Refers to physiological tremors (invisible to the naked eye) and functional tremors without brain organic lesions. Functional tremor includes: 1. Physiological tremor enhancement (visible to the naked eye), mostly posture tremor, associated with augmentation of adrenergic regulation; also seen in certain endocrine diseases such as pheochromocytoma, hypoglycemia, thyroid function Advance; 2. Cocaine and alcoholism and side effects of some drugs. Caries tremors, mostly heart-induced causes, distracting can alleviate tremors. 3. Others: tremors when emotions are intense and when doing fine movements. Benign tremor is clinically characterized by no such manifestations as Parkinson's disease such as myotonia, decreased movement, and abnormal posture.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.