brain, spinal cord, and nerve disorders
Tremor
Evaluation of Tremor
The following information can help people decide when a doctor's evaluation is needed and help them know what to expect during the evaluation. The following symptoms are cause for concern: Tremors that start abruptly Tremors in people who are under 50 years old and have no relatives who have had essential tremors Other neurologic symptoms, such as a change in mental status, muscle weakness, changes in the way a person walks, and difficulty speaking A rapid heart rate and agitation People with warning signs should see a doctor immediately. People without warning signs should see a doctor as soon as possible. If people are under 50 years old and do not have a family history of essential tremors, they should see a doctor soon. Being evaluated by a doctor is important to make sure that the cause is not another disorder or a drug. Doctors first ask questions about the person's symptoms and medical history and then do a physical examination. What doctors find during the history and physical examination often suggests a cause and the tests that may need to be done (see table Some Causes and Features of Tremor ). Doctors ask about the tremor: Whether the tremor began gradually or suddenly Which body parts are affected What triggers it (such as movement, rest, or standing) What relieves or worsens it (such as alcohol,caffeine, stress, or anxiety) Small amounts of alcohol may help relieve some types of tremors, but chronic alcoholism can cause brain damage that results in a tremor. If the tremor began suddenly, doctors ask about events that may have triggered it (such as a recent injury or use of a new drug). Doctors review the person's past medical history, looking for Types of Tremors . They ask about tremors in close relatives. They review the drugs taken and ask about use of Doctors do a physical examination, paying particular attention to the Neurologic Examination (including the way the person walks). Doctors note which body parts are affected by the tremor. They observe how fast the shaking movements are in various situations: When the affected body parts are at rest and when they are fully supported (for example, hands in the person's lap) While the person maintains certain positions (such as holding the arms outstretched) While the person is walking or doing tasks with the affected body part The quality of the person's voice may be observed when holding a long note. Doctors can usually identify the type of tremor based on its characteristics and results of the medical history and physical examination—for example, Tremors that develop gradually: Usually physiologic or essential tremor A postural tremor that starts suddenly: Possibly psychologic factors, a poison, a disorder (such as hyperthyroidism), stopping use of alcohol or another drug (such as a sedative), or use of a drug known to cause tremor Brain imagingwith magnetic resonance imaging (MRI) or computed tomography (CT) is done if The person has other neurologic symptoms that suggest a brain disorder, such as a stroke, a tumor, or multiple sclerosis. The tremor started suddenly or progresses rapidly. Blood testsmay be done to check for possible causes when the cause is unclear. Tests may include Measurement of blood sugar Tests to evaluate how well the thyroid and parathyroid glands, liver, and kidneys are functioning Electromyography and Nerve Conduction Studies None 