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Functional tremor — SCE Neurology MCQ

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ModerateMovement DisordersFunctional tremorSCE Neurology

A 63-year-old woman presented with variable tremor that entrained to voluntary rhythmic tapping. On examination, neurological examination showed distractibility and inconsistency. Initial investigations showed: DaTSCAN and thyroid function were normal. What is the most appropriate investigation?

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Correct answer: C — 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 Functional tremor: entrainment and distractibility are positive signs of functional tremor. MRI brain with diffusion-weighted imaging is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. MRI internal auditory meatus with gadolinium and CT angiography of the head and neck are less appropriate because they would require different localisation, timing or test findings; Genetic testing after counselling would fit a different syndrome. Clinical pearl: essential tremor is more consistent and does not entrain.

Reference: NICE NG71; Movement Disorder Society consensus criteria