Differential Diagnosis for Bilateral Hand Tremor with Rest and Movement

Single Most Likely Diagnosis

• Essential Tremor: This is the most common movement disorder and often presents with bilateral hand tremors that can occur at rest and with movement. The tremor is typically most noticeable during actions such as holding a cup or writing.

Other Likely Diagnoses

• Parkinson's Disease: Characterized by a resting tremor, bradykinesia, rigidity, and postural instability. The tremor in Parkinson's disease is classically most prominent at rest but can also be present with movement.
• Dystonic Tremor: A type of tremor that occurs in conjunction with dystonia, which is characterized by involuntary muscle contractions leading to abnormal postures. The tremor can be present at rest and with movement.
• Enhanced Physiological Tremor: An exacerbation of the normal physiological tremor that everyone has, which can be brought on by factors such as anxiety, caffeine, or certain medications. It is typically most noticeable with movement.

Do Not Miss Diagnoses

• Wilson's Disease: A rare genetic disorder that leads to copper accumulation in the body, particularly in the liver and brain. It can cause a variety of tremors, including those at rest and with movement, along with other neurological symptoms. Missing this diagnosis can lead to severe and irreversible neurological damage.
• Thyroid Dysfunction: Both hyperthyroidism and hypothyroidism can cause tremors, typically action tremors, but in some cases, they can also present with rest tremors. These conditions are treatable and can have significant consequences if not addressed.
• Medication-Induced Tremor: Certain medications can induce tremors as a side effect, including antipsychotics, antidepressants, and others. Recognizing and potentially changing the offending medication is crucial.

Rare Diagnoses

• Multiple System Atrophy (MSA): A rare neurodegenerative disorder that can present with tremors, among other symptoms like autonomic dysfunction and parkinsonism. The tremor can be at rest or with action.
• Progressive Supranuclear Palsy (PSP): Another rare neurodegenerative disorder that can cause tremors, though it is more commonly associated with difficulties in moving the eyes and a rigid, stooped posture.
• Cerebellar Disorders: Conditions affecting the cerebellum, such as cerebellitis or cerebellar degeneration, can cause intention tremors, which are most noticeable with movement towards a target.