Involuntary tremor of limbs

Introduction In daily life, we often see some elderly people's hands, heads or lower limbs involuntarily tremble or swing back and forth, which has a certain impact on the lives of the elderly. In fact, because many causes can cause limb involuntary tremor, it is necessary to identify the treatment. Tremor refers to the shaking and shaking of the head and limbs. Paralysis refers to the inability of a certain part or all of the limbs to move autonomously. Common in Parkinson's disease.

Cause

The cause of Parkinson's disease is not yet clear. Genetic factors, environmental factors, ageing, oxidative stress, etc. may all be involved in the degenerative death process of dopaminergic neurons in Parkinson's disease. It is currently recognized that the cause of the disease is the degeneration of nerve cells, the main lesions in the substantia nigra and striatum. There is a kind of nerve cells called substantia nigra cells. The number of substantia nigra cells is gradually reduced and the function is gradually lost. This causes a substance called dopamine to decrease, which causes disease symptoms.

an examination

Related inspection

EMG non-discrete motion check

According to the characteristics of insidious onset and gradual progress, unilateral involvement and progression to the contralateral side, manifested as resting tremor and slow movement, and can be diagnosed by excluding atypical Parkinson's disease-like symptoms. The treatment of levodopa is more effective in supporting the diagnosis. There were no abnormalities in routine blood and cerebrospinal fluid examination. There was no characteristic change in head CT and MRI. Olfactory examinations have found that patients with PD have a loss of sense of smell. Dopamine uptake functional PET imaging with 18F-dopa as a tracer showed reduced dopamine transmitter synthesis. Dopamine transporter (DAT) functional imaging with 125I--CIT and 99mTc-TRODAT-1 as tracers can show a decrease in the number of DAT, which can be reduced in the early stage of the disease or even in the subclinical stage, and can support the diagnosis. However, this inspection is more expensive and has not been routinely carried out.

Differential diagnosis

Mainly differentiated from idiopathic tremor and benign tremor.

(1) Parkinson's syndrome after encephalitis: Parkinson's syndrome caused by lethargy encephalitis has not been reported for nearly 70 years, so Parkinson's syndrome after encephalitis caused by this encephalitis disappear. 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 disease, about 1/3 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) idiopathic tremor: a dominant genetic disease, manifested as involuntary tremors of the head, jaw, and limbs. The frequency of tremor can be high or low, and the high frequency is similar to hyperthyroidism; the 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: this disease is also common in middle-aged and elderly patients, clinical symptoms may have 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 often have extrapyramidal symptoms, but due to prominent autonomic symptoms such as: syncope, orthostatic hypotension, sexual function and bladder dysfunction, levodopa preparation is ineffective, etc. Identification of 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 after withdrawal Alleviation can be identified.

(7) Benign tremor: refers to physiological tremor (invisible to the naked eye) and functional tremor without brain organic lesions. Functional tremor includes:

1. Physiological tremor is strengthened (visible to the naked eye), and most of them are postural tremor, which is related to the enhanced response of adrenaline. Also seen in certain endocrine diseases such as pheochromocytoma, hypoglycemia, hyperthyroidism.

2, cocaine and alcoholism and some side effects of drugs. Caries tremors, mostly heart-induced causes, distracting can alleviate tremors.

3, other: tremors when the mood is tense 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.

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