A 45-year-old Caucasian man comes to see you in the office. He is accompanied by his wife. They have noticed that he has shakiness of both hands for the past six months. The shakiness is limited only to his hands and has not progressed over time. It becomes much more pronounced when he tries to pick up things or attempts to eat or drink. On physical examination, you notice a constant tremor in both his hands, which becomes much more pronounced when his arms are outstretched. There is also a very subtle head tremor present. There is no rigidity or slowing of voluntary movements in the upper or lower extremities. His father had a similar problem in his 50s or 60s, but he is not sure what treatment he received at that time. His wife is extremely anxious and wants to know his prognosis.
Item 1 of 2
Which of the following is the most appropriate response?

Question

Quizplus · Accepted Answer

Explanation: The patient in the above vignette is most likely suffering from a familial tremor or benign essential tremor. It is the most common cause of postural tremor, and its incidence usually increases with age. The familial cases usually have an autosomal dominant inheritance pattern and presents at a relatively younger age. The tremor in patients with familial disease is usually present in the distal upper extremities and becomes much more pronounced with outstretching of the arm. It also increases at the end of an activity or movement. All patients with essential tremor typically do not have any other neurological signs. The absence of a resting tremor (which worsens at rest but improves with voluntary activity), rigidity (increased resistance to passive movements), bradykinesia (slowing of voluntary movements), or gait difficulty differentiates this condition from an early onset of Parkinson's disease. The presence of a positive family history and a head tremor is also more suggestive of an essential tremor. Benign essential or familial tremors usually do not cause any significant disability, and the patient can expect to have a normal life expectancy. There are no associated neurological symptoms in patients with benign essential tremors. (Choice B)The tremor in patients with benign essential or familial tremors usually worsens with time and can cause difficulty in the performance of fine motor tasks. (Choice C) The tremor can remain stable for years without any significant deterioration. It can cause significant disability in some, but not all the patients. (Choice D) Medications, especially beta-blockers, only have a limited effect on symptom control. They do not cause a complete resolution of the symptoms. Educational Objective: Benign essential tremors or familial tremors generally do not cause significant disabilities or neurological problems in patients.

A 45-Year-Old Caucasian Man Comes to See You in the Office. He