Quiz Form

Question Date: 28/10/2023

Question: A 47-year-old woman is referred for evaluation of imbalance. She reports that when she stands still she feels very unsteady and dizzy but when she walks she no longer has associated unsteadiness. The symptoms have been progressively worsening over time, and her primary care doctor was unable to explain her symptoms. On examination, she has normal blood pressure and pulse with no difference in the supine or standing position. A very low-amplitude postural tremor is evident in her arms, with no rigidity or bradykinesia. When she stands, she displays a subtle, high-frequency tremor in her legs and reports feeling off-balance.

Options:

• Dystonic tremor
• Orthostatic tremor
• Psychogenic tremor
• Wilson disease

Correct Answer: Orthostatic tremor

Explaination: This patient is experiencing the typical symptoms of orthostatic tremor. Orthostatic tremor usually presents with a sense of poor balance when standing, with associated very fine, high-frequency tremor in the legs. The tremor may be so subtle that the patient may not be aware of its presence. Walking generally relieves the symptoms. An associated postural tremor in the arms may be present. Patients may be misdiagnosed as psychogenic if the fine tremor of the legs upon standing is not identified

Reference: Edwards MJ, Deuschl G. Tremor syndromes. Continuum (Minneap Minn). 2013 Oct19(5 Movement Disorders)1213-24. doi 10.121201.CON.0000436153.01167.a6. PMID 24092287.