Tremor

Cerebellar Tremor

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Cerebellar Tremor, Rubral Tremor, Intention Tremor

  • See Also
  • 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
  • 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
  • Labs
  • Directed by suspected diagnosis
  1. Multiple Sclerosis: CSF for IgG gamma globulins
  2. Lithium Toxicity: Lithium Level
  • Imaging
  1. CT Head or MRI Brain
  • Management
  1. Identify Etiology
    1. Rule-out Cerebellar tumor
  2. Multiple Sclerosis
    1. Isoniazid (INH) 600-1200 mg qd
    2. Pyridoxine
  • Resources