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Essential tremor — SCE Neurology MCQ

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ModerateMovement DisordersEssential tremorSCE Neurology

A 18-year-old woman presented with bilateral hand tremor worse when writing and holding cups. On examination, there was no bradykinesia, rigidity or rest tremor. Initial investigations showed: thyroid function was normal and family history was positive. What is the most appropriate investigation?

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Correct answer: E — Clinical movement-disorder assessment with targeted DaTSCAN when uncertain

Clinical movement-disorder assessment with targeted DaTSCAN when uncertain is the best answer because the vignette describes Essential tremor: action tremor without parkinsonism is essential tremor. Lumbar puncture with CSF microscopy, culture and PCR is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. MRI brain with diffusion-weighted imaging and Genetic testing after counselling are less appropriate because they would require different localisation, timing or test findings; Video-EEG telemetry would fit a different syndrome. Clinical pearl: Parkinsonian tremor is classically rest-predominant with bradykinesia.

Reference: NICE NG71; Movement Disorder Society consensus criteria