A 62-year-old man has a bilateral fine postural tremor of the hands for 8 years, present equally at rest and on holding arms outstretched, improving transiently after two glasses of wine. There is no rigidity or bradykinesia, and his father had similar tremor. Best diagnosis:

• A Essential tremor ✓
• B Idiopathic Parkinson disease
• C Drug-induced parkinsonism
• D Wilson disease

Explanation

Essential tremor is a bilateral, symmetric, predominantly postural and kinetic tremor of long duration, often familial in autosomal dominant fashion, classically improved by alcohol, with absent bradykinesia and rigidity. Parkinsonian rest tremor appears asymmetrically after unilateral onset with accompanying bradykinesia and rigidity, and alcohol response plus the family history and preserved tone exclude both parkinsonism and Wilson disease here.

Reference: Adams and Victor's Principles of Neurology, 12th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.