Differential Diagnosis for Upper Extremity Tremors that are Intermittent
Single Most Likely Diagnosis
- Essential Tremor: This is the most common cause of tremors, characterized by intermittent, bilateral upper extremity tremors that are often exacerbated by movement or emotional stress. The tremors are typically most noticeable during actions such as writing or holding a cup.
Other Likely Diagnoses
- Parkinson's Disease: While Parkinson's disease is more commonly associated with resting tremors, some patients may exhibit intermittent tremors, especially in the early stages of the disease. Other symptoms such as bradykinesia, rigidity, and postural instability may also be present.
- Enhanced Physiological Tremor: This condition is an exaggeration of the normal physiological tremor that everyone experiences. It can be intermittent and is often exacerbated by factors such as stress, fatigue, or certain medications.
- Caffeine or Medication-Induced Tremor: Certain substances like caffeine, amphetamines, or certain antidepressants can cause or exacerbate intermittent tremors.
Do Not Miss Diagnoses
- Hyperthyroidism: Although less common, hyperthyroidism can cause tremors due to the metabolic effects of excess thyroid hormones. Missing this diagnosis could lead to significant morbidity if left untreated.
- Wilson's Disease: A rare genetic disorder that leads to copper accumulation in the body, causing neurological symptoms including tremors. Early diagnosis is crucial for effective treatment.
- Multiple Sclerosis: In some cases, multiple sclerosis can present with tremors, among other neurological symptoms. Given its potential for significant disability, it is a diagnosis that should not be missed.
Rare Diagnoses
- Fragile X-Associated Tremor/Ataxia Syndrome (FXTAS): A condition affecting older males with the fragile X premutation, characterized by tremors, ataxia, and other neurological symptoms.
- Neurodegeneration with Brain Iron Accumulation (NBIA): A group of rare genetic disorders characterized by iron accumulation in the brain, leading to various neurological symptoms including tremors.
- Spinocerebellar Ataxias: A group of autosomal dominant disorders that affect the cerebellum, leading to ataxia and sometimes tremors.