Clinical Reasoning: A 65-Year-Old Woman With Tremor

A 65-year-old woman was referred to our hospital for the evaluation of tremor, which had initially appeared in her right upper limb 3 years previously and progressed to her left upper limb and head 2 years previously. The tremor was most prominent during movement, but also occurred during rest. The patient felt unsteady when walking, although she denied falling and slowness of movement and symptoms of dysautonomia (e.g., positional lightheadedness, urinary dysfunction). She reported that her short-term memory had worsened and that the tremor intruded on her activities of daily living. The patient reported no medical history or previous trauma, hypoxic insult, or neurotoxic exposure, and no drug or alcohol use. There was no family history of tremor.

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