II. Causes

  1. Cerebellar Lesion (CVA or Tumor)
    1. Lesions of lateral cerebellar nuclei
    2. Lesions of cerebellar peduncle
    3. Lesions of red nucleus (Causes Rubral Tremor)
      1. Wing-beating type Tremor
      2. Rubral Tremor also seen in Wilson's Disease
  2. Cerebellar Postural Tremor
    1. Multiple Sclerosis with cerebellar Plaques (most common etiology)
    2. Frequency
      1. Mild: 10 Hz
      2. Severe: 2.5-4 Hz
    3. Amplitude waxes and wanes
  3. Wilson's Disease
  4. Psychogenic Tremor
  5. Drug-Induced Tremor
    1. Lithium
    2. Alcoholism
    3. Dystonic Tremor (estrapyramidal side effect)
      1. Typically drug induced, with onset age <50, with abnormal wrist flexion and jerky hand or arm positions

III. Findings: Symptoms and signs

  1. Intention Tremor on ipsilateral side of lesion
    1. Exacerbated Tremor at end of goal directed movement
    2. Low to Medium frequency Tremor
    3. Example: Finger-Nose-Finger
    4. Midline disease causes bilateral Tremor
    5. Contrast with Rest Tremor
      1. Rest Tremor improves with goal directed movement
  2. Tremor increases as extremity reaches target (with secondary dysmetria or over-shooting)
    1. Finger-Nose-Finger
    2. Heel-Knee-Shin
  3. Concurrent Cerebellar signs
    1. Abnormal Gait
    2. Speech abnormalities
    3. Ocular movement abnormalities
    4. Rapid Alternating Movements abnormal
    5. Abnormal Tandem Walk (esp. Multiple Sclerosis)
  4. Other findings
    1. Hypotonia

IV. Labs: Directed by suspected diagnosis

  1. Multiple Sclerosis: CSF for IgG gamma globulins
  2. Lithium Toxicity: Lithium Level

V. Imaging

  1. CT Head or MRI Brain

VI. Management

  1. Identify Etiology
    1. Rule-out Cerebellar tumor
  2. Multiple Sclerosis
    1. Isoniazid (INH) 600-1200 mg qd
    2. Pyridoxine

VII. Resources

Images: Related links to external sites (from Bing)

Related Studies

Ontology: Action Tremor (C0234376)

Concepts Sign or Symptom (T184)
MSH D014202
ICD10 G25.2
SnomedCT 30721006
English INTENTION TREMOR, Tremor Action, Tremor Intention, action tremor, intention tremor (physical finding), action tremor (physical finding), intention tremor, Tremor intention, Action Tremors, Tremor, Action, Tremors, Action, Intention Tremor, Intention Tremors, Tremor, Intention, Tremors, Intention, cerebellar tremors, kinetic tremor, action tremors, intention tremors, cerebellar tremor, intentioned tremors, volitional tremor, Tremor, intention, Tremor, action, Action tremor, Cerebellar tremor, Intention tremor, Kinetic tremor, Volitional tremor, Intention tremor (finding), tremor; intention, Hunt's tremor, Action Tremor
Dutch tremorintentie, intentietremor, tremor; intentie, intentie tremor, Actietremor, Intentietremor
Japanese 企図振戦, キトシンセン, ドウサジシンセン, 動作時振戦
Portuguese Tremor de Ação, TREMOR INTENSIONAL, Tremor de acção, Tremor intencional, Tremor de Intenção
Spanish Temblor de Acción, TEMBLOR DE INTENCION, Temblor de acción, temblor cerebeloso, temblor cinético, temblor intencional (hallazgo), temblor intencional, temblor por acción, temblor volitivo, Temblor intencional, Temblor de Intención
French Tremblement d'action, TREMBLEMENT INTENTIONNEL, Tremblement intentionnel, Tremblement cinétique, Tremblement d'intention
German Aktionstremor, INTENTIONSTREMOR, Intentionstremor
Czech Intenční třes, Intenční tremor, Akční třes, intenční tremor, akční třes
Hungarian Intenciós tremor, Intentiós tremor, Akciós tremor
Norwegian Intensjonstremor, Aksjonstremor
Italian Tremore d'azione, Tremore dinamico, Tremore cinetico, Tremore intenzionale

Ontology: Tremor, Rubral (C0750940)

Concepts Sign or Symptom (T184)
MSH D001259
French Tremblement rubral, Tremblement de Holmes
English Rubral Tremor, Rubral Tremors, Tremors, Rubral, Tremor, Rubral
Italian Tremore rubrale
Norwegian Holmes’ tremor, Tremor, rubral, Rubral tremor, Midthjernetremor