Differential Diagnosis for a Patient with Tremor
Single Most Likely Diagnosis
- Essential Tremor: This is the most common cause of tremor, characterized by a bilateral, symmetric tremor that typically affects the hands, but can also involve the head, voice, or other body parts. It is often familial and can be exacerbated by stress, fatigue, or certain medications.
Other Likely Diagnoses
- Parkinson's Disease: A neurodegenerative disorder that presents with a resting tremor, bradykinesia, rigidity, and postural instability. The tremor is typically unilateral and asymmetric at onset.
- Enhanced Physiological Tremor: An exacerbation of the normal physiological tremor that everyone has, often caused by stress, anxiety, fatigue, or certain medications like beta-agonists.
- Cerebellar Tremor: Caused by lesions or diseases affecting the cerebellum, characterized by an intention tremor, which worsens as the hand approaches a target.
Do Not Miss Diagnoses
- Wilson's Disease: A genetic disorder leading to copper accumulation in the brain and liver, which can cause a tremor, among other neurological and psychiatric symptoms. Missing this diagnosis can lead to severe liver and brain damage.
- Thyroid Dysfunction: Both hyperthyroidism and hypothyroidism can cause tremors. Hyperthyroidism is more commonly associated with tremors, but hypothyroidism can also cause a coarse tremor.
- Medication-Induced Tremor: Certain medications, such as lithium, valproate, and certain antipsychotics, can induce tremors as a side effect.
Rare Diagnoses
- Huntington's Disease: An autosomal dominant neurodegenerative disorder characterized by chorea (involuntary, abrupt movements), but can also present with tremors in some cases.
- Multiple System Atrophy (MSA): A rare neurodegenerative disorder that can present with tremors, along with other symptoms such as autonomic dysfunction, parkinsonism, and cerebellar ataxia.
- Fragile X-Associated Tremor/Ataxia Syndrome (FXTAS): A condition affecting older males with the fragile X premutation, characterized by tremor, ataxia, and other neurological symptoms.