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NEUROSAE 2018 ANNUAL MEETING EDITION (VOLUME 10, ISSUE 3)
QUESTION 98 OF 100
An otherwise healthy 36-year-old woman has a 3-month history of gradually progressive tremors in her hands, along with palpitations, occasional anxiety, and periods of feeling hot despite regular menstrual cycles. She also reports an unintentional 15-lb weight loss over the past 3 months. Family history includes a paternal grandfather with Parkinson’s disease, her mother and maternal aunts with thyroid disease, and her father with tremors and a history of alcoholism but otherwise healthy. She denies drinking alcohol. Results of a neurologic examination show low-amplitude, high-frequency 8- to 12-Hz tremors. She takes ibuprofen occasionally for headaches and an oral contraceptive. Which of the following underlying issues is a probable cause of her tremors?
A. Parkinson’s disease
B. Essential tremors
C. Thyrotoxicosis **
D. Oral contraceptive use
E. Cerebellar tumor
** = Your answer
Tremors can occur at rest, in a postural state, or during activity. Physiologic tremors are characteristically low amplitude and high frequency at 8 to 12 Hz. Tremors are more pronounced with emotional states, fatigue, exercise, alcohol use, and concurrent use of drugs such as valproic acid, selective serotonin reuptake inhibitors (SSRIs), and lithium. Thyrotoxicosis is a possible diagnosis for this patient, as she has clinical symptoms of hyperthyroidism, anxiety, palpitations, heat intolerance, and weight loss. She is young for Parkinson’s disease, does not consume alcohol, and has no other clinical symptoms suggestive of cerebellar involvement. Use of oral contraceptives is not known to cause tremors.
* Louis ED. Diagnosis and management of tremor. Continuum Lifelong Learning Neurol. 2016;22(4):1143-1158.