Case history
Case history
A 68-year-old woman presents with a complaint of "shaking hands." She reports a 10-year history of bilateral hand tremor that has slowly progressed and is worse in her right hand. It mainly bothers her when she is using her hands for various tasks. She has great difficulty drinking from cups and eating peas and other foods, and uses either a straw or both hands to eat and drink. She also finds writing and sending text messages problematic. She has come to rely increasingly on her spouse for assistance with activities of daily living, and has retired from work as a secretary. She has stopped eating out in restaurants because of the social embarrassment. She denies any slowness of movement, rigidity, or cramping. Her father has a long history of tremor, but otherwise she has no personal or family history of neurologic diseases. When the patient has a glass of red wine, she notes that her tremor abates.
Other presentations
There have been isolated reports of cognitive difficulties (i.e., verbal, memory, and mental adaptiveness) and possibly personality changes in patients with essential tremor (ET).[8][9][10][11] In addition, while ET is usually characterized by postural and/or kinetic tremor, rest tremor has occasionally been reported. In one study of 64 patients with ET, 12 (19%) had a tremor at rest and a more longstanding and severe disease than those without rest tremor.[12][13] Subtle ataxic gait, such as tandem gait impairment, has also been observed in ET patients; ataxia can become more severe in a subset of ET patients with advanced disease.
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