Tremor: Or something else? Differential Diagnosis

Congenital malformations, deformities, and chromosomal abnormalities (Q00-Q99).

  • Fragile X-associated tremor ataxia syndrome – genetic disorder with X chromosomal dominant inheritance; adult-onset gait disturbance and increasing intention tremor (trembling of the limbs during a purposeful movement).

Respiratory System (J00-J99)

Endocrine, nutritional and metabolic diseases (E00-E90).

  • Diabetes mellitus (diabetes) with polyneuropathy (nerve damage).
  • Hyperparathyroidism (parathyroid hyperfunction).
  • Hyperthyroidism (hyperthyroidism) – Graves’ disease.
  • Hypoglycemia (hypoglycemia)
  • Hypocalcemia (calcium deficiency)
  • Hypokalemia (potassium deficiency)
  • Hypomagnesemia (magnesium deficiency)
  • Wilson’s disease (copper storage disease) – autosomal recessive inherited disease in which copper metabolism in the liver is disturbed by one or more gene mutations.
  • Porphyria or acute intermittent porphyria (AIP); genetic disease with autosomal-dominant inheritance; patients with this disease have a 50 percent reduction in the activity of the enzyme porphobilinogen deaminase (PBG-D), which is sufficient for porphyrin synthesis. Triggers of a porphyria attack, which can last a few days but also months, are infections, drugs or alcohol. The clinical picture of these attacks presents as acute abdomen or neurological deficits, which can take a lethal course. The leading symptoms of acute porphyria are intermittent neurologic and psychiatric disturbances. Autonomic neuropathy is often in the foreground, causing abdominal colic (acute abdomen), nausea (nausea), vomiting, or constipation, as well as tachycardia (belongs to paroxysmal supraventricular tachycardia and leads to typical seizure-like episodes with tachycardia (heartbeat too fast: > 100 beats per minute), dizziness, and possibly signs of heart failure. Signs of acute heart failure (heart failure)) and a labile hypertension (high blood pressure).
  • Vitamin B12 deficiency

Cardiovascular system (I00-I99)

  • Apoplexy (stroke)

Infectious and parasitic diseases (A00-B99).

  • Creutzfeld-Jakob disease
  • HIV infection
  • TBE (early summer meningoencephalitis)
  • Morbilli (measles)
  • Neurolues – late form of syphilis, which leads to various neurological deficits.
  • Smallpox
  • Porphyria – hereditary metabolic disease that leads to deposits in various organs.
  • Typhoid fever – infectious disease caused by Salmonella typhi.
  • Varicella (chickenpox)

Liver, gallbladder and bile ducts – Pancreas (pancreas) (K70-K77; K80-K87).

Neoplasms – tumor diseases (C00-D48)

  • Brain tumors, unspecified

Psyche – nervous system (F00-F99; G00-G99).

  • Alcohol dependence
  • Atrophies (tissue atrophy) in the central nervous system
  • Drug withdrawal (alcohol/alcohol withdrawal, benzodiazepines, opiates).
  • Hereditary (hereditary) neurological disorders such as Fahr’s disease, benign hereditary chorea.
  • Complex regional pain syndrome (engl.Complex regional pain syndrome (CRPS); synonyms: Algoneurodystrophy, Sudeck’s disease, Sudeck’s dystrophy, Sudeck-Leriche syndrome, sympathetic reflex dystrophy (SRD)) – neurological-orthopedic clinical picture that is based on an inflammatory reaction after injury to an extremity and in which central pain processing is also involved in the event; represents a symptomatology in which there are severe circulatory disturbances, edema (fluid retention) and functional restrictions after the intervention, as well as hypersensitivity to touch or pain stimuli; Occur in up to five percent of patients after distal radius fractures, but also after fractures or minor trauma to the lower extremity; early functional treatment (physical and occupational therapy), with medications for neuropathic pain (“nerve pain) and with topical (“local”) therapies lead to better long-term results.
  • Medication withdrawal
  • Meningoencephalitis (inflammation of the meninges and brain).
  • Parkinson’s disease
  • Multipe sclerosis (MS) – demyelinating disease that causes paralysis and sensory disturbances in particular.
  • Peripheral neuropathies – nerve damage to peripheral nerves – such as Charcot-Marie-Tooth, Guillain-Barré syndrome (GBS; synonyms: Idiopathic polyradiculoneuritis, Landry-Guillain-Barré-Strohl syndrome); two courses: acute inflammatory demyelinating polyneuropathy or chronic inflammatory demyelinating polyneuropathy (disease of the peripheral nervous system); idiopathic polyneuritis (diseases of multiple nerves) of the spinal nerve roots and peripheral nerves with ascending paralysis and pain; usually occurs after infections; here intention tremor / tremor of the limbs during a purposeful movement.
  • Spatial lesions in the central nervous system such as cysts
  • Somatoform disorder (anxiety, inner turmoil)
  • Spinocerebellar ataxia – form of gait disorder caused by atrophy of spinal cord tracts.

Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99).

  • Dystonic tremor (moderate-frequency holding and movement tremor around 5-8 Hz) – tremor in the setting of dystonia (presence of sustained or intermittent involuntary muscle tension); tremor is characterized by dysfunction in the control of movement
  • Essential tremor (moderate-frequency holding and movement tremor around 5-8 Hz) – occurs without an identifiable underlying neurological disease; most common form of tremor (approximately 1% of the population; twin studies estimate hereditary component at 45-90%)
  • Holmes tremor (synonyms: rubral tremor, midbrain tremor, myorhythmia, Bendict syndrome) – onset after weeks to years of brain lesion (low frequency (2-5 Hz) and coarse-beat amplitude) – usually unilateral resting, holding, and intention tremor
  • Neuropathic tremor (4-8 Hz and coarse-beat amplitude).
  • Orthostatic tremor (OT; non-visible, high-frequency tremor (12-20 Hz) – leads to a clear insecurity in standing when the leg muscles are tensed while standing; patients complain of a feeling of weakness in the legs after standing up, rubber legs, insecurity in standing and balance problems; walking is usually hardly affected by this; course usually progressive (progressing)
  • Uremia (occurrence of urinary substances in the blood above the normal values) with polyneuropathy (nerve damage).

Genitourinary system (kidneys, urinary tract – sex organs) (N00-N99).

  • Renal dysfunction, unspecified
  • Renal insufficiency (kidney weakness)

Injuries, poisoning, and other consequences of external causes (S00-T98).

  • Brain injuries

Further

  • Drug withdrawal
  • Cold
  • Muscle fatigue
  • Strong emotions, stress, exhaustion

Medication

Environmental pollution – intoxications (poisoning).

  • Alcohol
  • Arsenic
  • Lead
  • Cyanide
  • Dichlorodiphenyltrichloroethane (DDT)
  • DioxinNote: Dioxin belongs to the endocrine disruptors (synonym: xenohormones), which even in the smallest amounts can damage health by altering the hormonal system.
  • Kepon
  • Carbon monoxide
  • Cocaine
  • Lindane
  • Naphthalene
  • Manganese
  • Nicotine
  • Phosphorus
  • Mercury
  • Toluene