Differential Diagnosis for Resting Tremor in a 68-year-old Female
Single Most Likely Diagnosis
- Parkinson's Disease: This is the most common cause of resting tremor in the elderly. The typical presentation includes a unilateral resting tremor, bradykinesia, rigidity, and postural instability. The age of the patient and the presence of a resting tremor make Parkinson's disease the most likely diagnosis.
Other Likely Diagnoses
- Essential Tremor: Although essential tremor typically presents as an action tremor, some patients may exhibit a resting tremor. It is less likely than Parkinson's disease but still a common cause of tremor in the elderly.
- Dementia with Lewy Bodies: This neurodegenerative disorder can present with tremors, cognitive decline, and hallucinations. The presence of cognitive decline or hallucinations in addition to a resting tremor would increase the likelihood of this diagnosis.
- Medication-Induced Tremor: Certain medications, such as antipsychotics, antidepressants, and lithium, can cause tremors. A thorough medication history is essential to consider this diagnosis.
Do Not Miss Diagnoses
- Wilson's Disease: Although rare, Wilson's disease is a potentially treatable cause of tremor that can be fatal if missed. It typically presents in younger patients but can occur at any age. A family history of the disease or the presence of Kayser-Fleischer rings would increase the suspicion for Wilson's disease.
- Thyroid Storm: Hyperthyroidism can cause tremors, and thyroid storm is a life-threatening condition that requires immediate attention. Although less common, it is essential to consider this diagnosis, especially if the patient has a history of thyroid disease.
- Pheochromocytoma: This rare tumor can cause episodic tremors, hypertension, and other symptoms. Although unlikely, it is a potentially life-threatening condition that should not be missed.
Rare Diagnoses
- Spinocerebellar Ataxia: This group of genetic disorders can cause tremors, ataxia, and other neurological symptoms. The presence of a family history or other neurological symptoms would increase the likelihood of this diagnosis.
- Fragile X-Associated Tremor/Ataxia Syndrome (FXTAS): This rare genetic disorder can cause tremors, ataxia, and cognitive decline in older adults. A family history of fragile X syndrome or the presence of other characteristic features would increase the suspicion for FXTAS.
- Neurodegeneration with Brain Iron Accumulation (NBIA): This group of rare genetic disorders can cause tremors, dystonia, and other neurological symptoms. The presence of a family history or other characteristic features, such as iron accumulation on brain imaging, would increase the likelihood of this diagnosis.