Resting tremor, or "pill-rolling tremor", is mainly seen in Parkinson's disease. It occurs at rest and is relieved by intentional movement. The hands are the typical site of involvement.
A postural tremor is different from a resting tremor in that it occurs due to voluntary muscle contraction, especially when the individual must hold their posture against gravity (e.g., while holding the arms outstretched).
Essential tremor is the most common type of tremor and has a correlation with family history. It is a high-frequency tremor. It can be seen in the hands, arms, head, and larynx. It can be asymmetrical. The symptoms typically worsen with movement or anxiety and improve with alcohol intake. Therapy may include propranolol and primidone.
Physiologic tremors can present in any healthy individual. They may be induced by sympathetic stimulation, including emotional stress, fatigue, exercise, caffeine, valproate, hyperthyroidism, pheochromocytoma, and magnesium deficiency. These are reversible if the etiology is found and treated.
Intention tremor is a tremor that occurs due to cerebellar dysfunction. When the patient is asked to point to something with his finger, the patient's finger may move in a zigzag pattern.
Asterixis is a flapping tremor with periodic loss of postural muscle tone. With the patient's arms in extension, corrective movements may be seen. Hyperammonemia is thought to be the main causative factor. It is associated with hepatic encephalopathy and uremia. Management is centered around treating the underlying disorder.
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