Table 3

Clues to pathogenesis obtained from examination of the patient

Examination of a tremulous patient's relatives or their photographs may be useful.
KF, Kayser-Fleischer; LMN, lower motor neuron; MS, multiple sclerosis.
Signs of:

  • Parkinsonism—bradykinesia, rigidity, postural instability

  • Cerebellar disease—eye movements, speech

  • Dystonia—spasmodic torticollis, vocal dystonia, writer's cramp

  • Neuropathy—pes cavus, LMN signs, sensory signs

  • Drug induced dyskinesia—orofacial dyskinesia

  • Multiple sclerosis—other signs of MS usually evident

  • Orthostatic tremor—unsteadiness and palpable leg tremor on standing

  • Alcoholism—signs of liver disease

  • Wilson's disease—KF rings, splenomegaly, hepatosplenomegaly