Tremor

Question 1

Neuro Causes

Answer 1

Unilateral

• Parkinson’s Disease
• Intention tremor (cerebellar)

Bilateral
- Benign Essential Tremor

Question 2

Endocrine Causes

Answer 2

Bilateral

- Hyperthryoid

Question 3

Psychiatric Causes

Answer 3

Bilateral

- Anxiety

Question 4

Iatrogenic Cases

Answer 4

Bilateral

• Salbutamol Overuse
• Lithium

Question 5

Other

Answer 5

Bilateral

- Alcohol withdrawal
- CO2 Retention
- Hepatic Flap

Question 6

Bedside Ix

Answer 6

Observations
Cerebellar/CN exam

ABG: Check CO2 retention

Question 7

Bloods

Answer 7

FBC, UEs, LFTs, CRP
Lithium levels
Blood cultures (encephalopathy)

Question 8

Imaging

Answer 8

CT Head

- cerebellar stroke/disease

Question 9

DANISH

- Cerebellar sx

Answer 9

D: Dysdiadochokinesia/dysmetria  (past pointing)
A: Ataxia
N: Nystagmus
I: Intention Tremor
S: Speech
H: Hypotonia

Question 10

PASTRIES

- Cerebellar disease causes

Answer 10

P: Posterior fossa tumour
A: Alcohol
S: Multiple sclerosis
T: Trauma
R: Rare
I: Inherited (e.g. Friedreich's ataxia)
E: Epilepsy medication (carbamazepine, phenytoin toxicity)
S: Stroke

Question 11

Fam Hx

Answer 11

Benign Essential Tremor

• AD
• Worse with age

Freidrich’s Ataxia
- Unbalance, cerebellar disorders

Question 12

Drug Hx

Answer 12

Salbutamol
Lithium
Anti-epileptics (valproate)
Immunosuppressants (tacrolimus)

Question 13

Social Hx

Answer 13

Alcohol use