A 60-year-old woman presents with a tremor. Which one of the following features would suggest a diagnosis of essential tremor rather than Parkinson's disease?
A. Difficulty in initiating movement
B. Tremor is worse following alcohol
C. Postural instability
D. Unilateral symptoms
E. Tremor is worse when the arms are outstretched
Answer:
E. Tremor is worse when the arms are outstretched
Discussion: Difficulty in initiating movement (bradykinesia), postural instability and unilateral symptoms (initially) are typical of Parkinson's.
Essential tremor symptoms are usually eased by alcohol.
Essential tremor (previously called benign essential tremor) is an autosomal dominant condition which usually affects both upper limbs
Clinical Features
postural tremor: worse if arms outstretched
improved by alcohol and rest
most common cause of titubation (head tremor)
Management
propranolol is first-line
primidone is sometimes used
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