A 58-year-old woman with a position-dependent tremor

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A 58-year-old woman with a position-dependent tremor Teaching NeuroImages Neurology Resident and Fellow Section © 2018 American Academy of Neurology

Vignette An otherwise healthy 58-year-old woman presented with a two-year history of a right-hand jerky tremor solely when she curled her hair The tremor was present exclusively during action and was alleviated with slight changes in position The tremor dissipated when she touched the dorsum of her affected hand with her left hand. There were no signs of parkinsonism. Her tremor had remained stable for the past two years Sharma et al. © 2018 American Academy of Neurology

Video Sharma et al. Video Legend: While holding a water bottle as she would a hair curler, the patient demonstrated an action-induced tremor that was task-specific (holding the “hair curler” above her head as if about to curl her hair) (segment 1), weight-sensitive (more water, larger tremor amplitude) (segment 2), position-dependent (a given combination of wrist flexion and arm pronation-supination elicited the tremor) (segment 3), and responsive to a sensory trick (closed-loop sensory feedback) (segment 4). Sharma et al. © 2018 American Academy of Neurology

Clinical features of a dystonic tremor Dystonia is characterized by sustained or intermittent muscle contractions causing postures and abnormal movements that may appear patterned, twisting and/or tremulous (1). This tremor is action-induced, position-dependent, task-specific, weight-sensitive and ameliorates with a sensory trick, “Geste Antagoniste” (1,2). Rarely manifesting as an isolated tremor, dystonic tremor syndromes have a wide range of etiologies that require historical and clinical correlation (2) Albanese A, Bhatia K, Bressman SB, DeLong MR, Fahn S, Fung V, et al. Phenomenology and classification of dystonia: a consensus update. Mov Disord. 2013; 28: 863–873. 2. Bhatia KP, Bain P, Bajaj N, Elble RJ, Hallett M, Louis ED, et al. Tremor Task Force of the International Parkinson and Movement Disorder Society. Consensus Statement on the classification of tremors. from the task force on tremor of the International Parkinson and Movement Disorder Society. Mov Disord. 2018 Jan;33(1):75-87. Sharma et al. © 2018 American Academy of Neurology