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Shake your hand at rest!

Topic: Adult

Created on Thursday, October 23 2008 by rednucleus

Last modified on Thursday, October 23 2008.

A middle-aged woman visits the movement disorder clinic because of hand instability. You have detected tremor but you are not sure whether this is due to Parkinson's disease or due to essential tremor. Which one of the following is suggestive of Parkinson's disease?

A) Head tremor

B) Positive family history

C) Flexor planters

D) Unilateral tremor

E) Normal serum ceruloplasmin

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This question was created on October 23, 2008 by rednucleus.
This question was last modified on October 23, 2008.

ANSWERS AND EXPLANATIONS

A) Head tremor

This answer is incorrect.

"Jaw" tremor is seen in Parkinson's disease, but "head" tremor (like yes-yes or no-no) is seen in essential tremor. (See References)


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B) Positive family history

This answer is incorrect.

Occurs in both, essential tremor and Parkinson's disease. Note that tremor is absent in 30% of Parkinson's patients at the time of diagnosis. (See References)


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C) Flexor planters

This answer is incorrect.

Occurs in both, essential tremor and Parkinson's disease; note that upper motor neuron signs are NOT compatible with Parkinson's disease). (See References)


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D) Unilateral tremor

This answer is correct.

The tremor of Parkinson's disease always starts on one side and then involves the other by months and even years; symmetrical bilateral tremor on presentation should cast a strong doubt on the diagnosis of Parkinson's disease. Note that idiopathic Parkinson's disease is a "clinical" diagnosis; imaging studies are ordered when the presentation is atypical (e.g. right-sided weakness, extensor planters, axial rigidity, papilloedema,...etc). (See References)


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E) Normal serum ceruloplasmin

This answer is incorrect.

Occurs in both, essential tremor and Parkinson's disease. Note that serum ceruloplasmin is low in 95% of cases of Wilson's disease. (See References)


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References:

1. Victor, M., and Ropper, A.H. (2001). Adams and Victor's Principles of Neurology, 7th Edition. McGraw-Hill, New York. (ISBN:0070674973)

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adult
Shake your hand at rest!
Question ID: 102308122
Question written by rednucleus. (C) FrontalCortex.com 2006-2009, all rights reserved. Created: 10/23/2008
Modified: 10/23/2008
Estimated Permutations: 120