Differential Diagnosis for Bilateral Hand Tremor
- Single most likely diagnosis
- Essential Tremor: This is the most common cause of bilateral hand tremor, characterized by a postural or action tremor that is often familial and can be exacerbated by stress, fatigue, or certain medications.
- Other Likely diagnoses
- Parkinson's Disease: Although typically asymmetric, Parkinson's disease can present with bilateral hand tremor, especially in the early stages. Other symptoms such as bradykinesia, rigidity, and postural instability may accompany the tremor.
- Enhanced Physiological Tremor: This condition is an exaggeration of the normal physiological tremor that everyone experiences and can be caused by factors such as anxiety, stress, fatigue, or certain medications like beta-agonists.
- Dystonic Tremor: This type of tremor occurs in association with dystonia, a movement disorder characterized by sustained or intermittent muscle contractions leading to abnormal postures.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Wilson's Disease: A rare genetic disorder that leads to copper accumulation in the body, causing neurological symptoms including tremor, ataxia, and psychiatric symptoms. Early diagnosis is crucial as treatment can prevent progression.
- Thyrotoxicosis: Hyperthyroidism can cause a tremor due to the metabolic effects of excess thyroid hormones. Missing this diagnosis could lead to untreated hyperthyroidism with significant morbidity.
- Rare diagnoses
- Multiple System Atrophy (MSA): A rare neurodegenerative disorder that can present with tremor, ataxia, parkinsonism, and autonomic dysfunction.
- Spinocerebellar Ataxias: A group of genetic disorders affecting the cerebellum and sometimes other parts of the brain, leading to ataxia and can include tremor as a symptom.
- 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 tremor.