Chapter 10 Tremor and cerebellar signs

Video 50 Task-specific or task-exacerbated variant of essential tremor without postural tremor in an elderly woman with a 30-year history of handwriting tremor in the right hand that later spread to the left hand, with mild head tremor.

Video 51 Resting tremor in Parkinson’s disease

Hand tremor persisting during walking in a patient with Parkinson’s disease

Video 52 Resting tremor in Parkinson’s disease

A highly coordinated synchronous rhythmical contraction in the plane of flexion and extension is seen in the fingers of the left hand. In the right hand, the tremor is pill-rolling, the thumb rubbing against the index. A side-to-side tremor of similar frequency is seen in the jaw.

Video 53 Postural tremor in essential tremor

Fine tremor of the outstretched arms; this goes when the arms are at rest and persists during movement; no akinesia of the hands.

Video 54 Parkinson’s disease and childhood-onset hereditary chin tremor

Video 55 Intention tremor

A coarse (high-amplitude, low-frequency) tremor is seen in the right hand as the index finger approaches the pointer and the patient’s nose.

Video 56 Intention tremor in cerebellar disease

The patient develops a coarse tremor of the hand as her finger approaches her nose, especially on the right side; there is clumsiness (ataxia) of the hands when she slaps her thighs.

Video 57 Tremor, akinesia and gait in Parkinson’s disease

While sitting, there is a coarse tremor of the right hand, causing f lexion and extension at the wrist. The tremor pauses brief ly when he raises the arms. There is slowing of voluntary f lexion and extension of the hands (bradykinesia). The chin shakes. He does not swing the (tremulous) right arm on walking.

Video 58 Falls in Parkinson’s disease

The patient walks cautiously with small steps and with a coarse tremor of the right hand. When he crosses the shadow thrown by light coming through the doorway, he freezes and falls to his knees.

Video 59 Speech in Parkinson’s disease

A quiet voice with a tendency to stutter (pallilalia).

Video 60 Holmes tremor

Coarse postural and intention tremor in a patient with midbrain lesion.

Video 61 Bat’s wing tremor in a patient with Wilson’s disease

At rest, he has a head tremor (titubation); with the arms abducted at the shoulder and flexed at the elbow, he develops a coarse asymmetrical proximal tremor of the arms.

Video 62 Slow tremor (myorhythmia) in a patient with Wilson’s disease

Video 63 Progressive multiple system atrophy manifested by severe bradykinesia, dysarthria, dysautonomia with orthostatic hypotension, respiratory, gastrointestinal and urinary failure and marked sialorrhoea, precipitated by eating chocolate.