Jaw Tremors and Asymmetric hand Tremors in a Case of Essential Tremors

A 65-year old lady presented with six years history of tremors affecting both upper limbs, left more than right. I had periodically seen her during these 6 years. Tremors were of postural type and affected left upper limb more than the right upper limb. She developed jaw tremors for the past 3-6 months, which were present at rest. There was no rigidity or bradykinesia. She had no problems with speaking or swallowing. There was no history of stroke. Brain MRI was within normal limits.

A diagnosis of essential tremors (ETs) was made. A few learning points from this case:

  1. Essential tremors need not symmetrically involve upper limbs. In fact, careful evaluation reveals asymmetric tremors in upper limbs in many cases of ETs.
  2. Jaw tremors, through classically seen in parkinson’s disease, can be seen in 10-15% of patients suffering from essential tremors.

She was started on propranolol tablets, with which she had significant reduction of jaw and hand tremors.

Published by Dr Sudhir Kumar MD (Medicine) DM (Neurology)

I am a doctor with 25 years experience. I have worked as a neurologist for about 20 years. Educating public and healthcare professionals is very dear to me. This is possible due to my interactions with thousands of patients and their caregivers. I salute the patients who suffer and it is our duty to minimise suffering by preventing diseases and ensuring prompt diagnosis and treatment of those already affected.

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