Differential Diagnosis for a Woman with Uncontrollable Shaking

• Single most likely diagnosis:
  • Essential Tremor: This is a common movement disorder characterized by tremors during action or with posture, which could be mistaken for the body "shaking." It's more common in older adults but can occur at any age.
• Other Likely diagnoses:
  • Anxiety or Panic Attack: Severe anxiety can cause significant physical symptoms, including trembling or shaking, due to the body's "fight or flight" response.
  • Hypoglycemia (Low Blood Sugar): Especially in diabetic patients, low blood sugar can cause shakiness, sweating, and confusion.
  • Hyperthyroidism: An overactive thyroid gland can lead to tremors, among other symptoms like weight loss, palpitations, and heat intolerance.
  • Caffeine or Nicotine Withdrawal: Withdrawal from these substances can cause tremors and shakiness.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Stroke or Transient Ischemic Attack (TIA): While less common, a stroke or TIA can present with sudden onset of tremors or shaking, especially if accompanied by other neurological deficits.
  • Severe Infection or Sepsis: Infections can cause systemic inflammation, leading to a variety of symptoms including shakiness or tremors, especially in vulnerable populations.
  • Neuroleptic Malignant Syndrome (NMS): A rare but life-threatening side effect of neuroleptic medications, characterized by fever, muscle rigidity, and altered mental status, which could initially present with shaking.
• Rare diagnoses:
  • Wilson's Disease: A genetic disorder leading to copper accumulation in the body, which can cause tremors, among other neurological and psychiatric symptoms.
  • Parkinson's Disease: Although more commonly associated with rigidity and bradykinesia, some forms of Parkinson's can present with tremors.
  • Multiple Sclerosis: An autoimmune disease affecting the brain and spinal cord, which can cause a wide range of neurological symptoms, including tremors.

Each of these diagnoses has a different set of accompanying symptoms and requires a distinct approach to diagnosis and treatment. A thorough medical history, physical examination, and appropriate diagnostic tests are essential for determining the underlying cause of the shaking.