Clinical notes
Orthostatic tremor: Delayed onset following head trauma

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Abstract

Orthostatic tremor is a 14 to 16Hz (range 7 to 36Hz) tremor of uncertain etiology elicited within seconds of an isometric contraction. It is described as a shaking, cramping of the lower extremities upon standing and is relieved with movement or sitting. Typically patients are unable to stand in place for long periods of time secondary to instability and fatigue. A 73-year-old woman with orthostatic tremor following a history of head trauma is presented. Recognition of the characteristic history and electromyographic findings may lead to appropriate treatment for this annoying and sometimes incapacitating disorder.

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  • Orthostatic tremor: A review of 45 cases

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    OT has been associated with Graves disease [19], thiamine deficiency [20], monoclonal and biclonal gammopathy of underdetermined significance [21,22], and small cell cancer lung cancer with positive anti-Hu antibodies [23]. Other unusual associations include delayed onset OT after head trauma [24], a nonenhancing structural lesion in the left dorsolateral midbrain [25] and lesions (schwannoma and tuberculoma) affecting the pontine structures [26]. Abnormal activation of a central tremor generator by a unilateral structural lesion may cause bilateral OT.

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    Most cases of OT are idiopathic, with normal magnetic resonance imaging of the brain. Symptomatic OT does occur (Fig. 35.2) and has been described in patients with ET (Papa and Gershanik, 1988; FitzGerald and Jankovic, 1991), pontine lesions (Benito-Leon et al., 1997; Setta and Manto, 1998), cerebellar degeneration (Manto et al., 1999), head trauma (Sanitate and Meerschaert, 1993), aqueduct stenosis, relapsing polyradiculoneuropathy (Gabellini et al., 1990), paraneoplastic syndrome associated with small-lung cancer (Gilhuis et al., 2005), Graves' disease (Tan et al., 2008), parkinsonism, restless-legs syndrome (Gerschlager et al., 2004), and thiamine deficiency (Nasrallah and Mitsias, 2007). Of particular interest is the association of OT with parkinsonism.

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