Differential Diagnosis for Tremor
To distinguish essential tremor from Parkinsonian tremor, consider the following categories:
- Single most likely diagnosis
- Essential tremor: This is the most common movement disorder, characterized by a bilateral, symmetric tremor, often affecting the hands, head, or voice. It typically worsens with action and improves with rest.
- Other Likely diagnoses
- Parkinson's disease: A neurodegenerative disorder that presents with a resting tremor, bradykinesia, rigidity, and postural instability. The tremor is often asymmetric and pill-rolling in nature.
- Dystonic tremor: A type of tremor that occurs in conjunction with dystonia, characterized by involuntary muscle contractions and abnormal postures.
- Enhanced physiological tremor: An exaggerated physiological tremor, often caused by factors such as anxiety, stress, or certain medications.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Wilson's disease: A rare genetic disorder that can cause tremors, ataxia, and other neurological symptoms, as well as liver disease. If left untreated, it can be fatal.
- Multiple system atrophy: A rare neurodegenerative disorder that can present with tremors, ataxia, and autonomic dysfunction.
- Rare diagnoses
- Orthostatic tremor: A rare type of tremor that occurs when standing and is often associated with a feeling of unsteadiness.
- Neuropathic tremor: A tremor caused by peripheral nerve damage, which can be seen in conditions such as peripheral neuropathy or radiculopathy.
- Psychogenic tremor: A tremor with a psychological origin, often associated with conversion disorder or factitious disorder.