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Neurology (Expert Forum)
Right Arm Tremor
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Right Arm Tremor
by saly__0__0, Dec 20, 1998 12:00AM
Dear Doctor, Let me type our findings on the MRI. This is just the impression. There is probably dilated perivesicular space at the inferior aspect of the basal ganglia on the right side. There is slight prominence of the cisterna magna. No mass lesion is seen. No abnormal enhanced lesion is identified with gadolinium injection. There is minimal mucasol thickening demonstraed in the max. sinuses. His right arm tremor is still with him sometimes it seems worse than others, but he is on vacation from school so he hasnt been writing as much. Although he did say that when he was trying to drink the other night he did have some difficulty. We will see his Doctor on Tuesday to get the blood results of a thyroid and test for Wilsons Disease. but I still would appreciate any suggestions you might have. I truely appreciate how quickly you returned my last posted note thank you again and have a Happy New Year!!! Sally
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The MRI interpretation suggests that there is no structural damage to the cerebellum or the connections with other parts of the brain. If the problem is in the cerebellum, AND if it is localized to one side or one limb, then you would expect some abnormality. There are cerebellar diseases in which the MRI shows nothing abnormal, but usually the whole cerebellum is affected (some biochemical problem, for example) and not just the part that controls one limb. Therefore, I suspect the cerebellum is not involved (based on limited data, of course, in this forum).
It is possible your son has a dystonic tremor, which often has no associated structural damage and therefore a normal MRI.
If they were checking for Wilson's disease, they were smart. That is an incredibly rare disease, and usually the test is negative, but your doctors don't want to miss the opportunity to find an important treatable disease. It will probably be a negative test, though.
Dystonia comes in many flavors, and is not just one disease. There are syndromes of dystonia that begin in childhood; others begin in adulthood. Sometimes dystonia shows up in limbs (arms, legs), other times in the neck or trunk or face or even voice. Usually, dystonia reveals itself as a tendency to develop unusual sustained postures (of the affected body part) or perhaps jerking, but occasionally the primary manifestation is an unusual tremor.
Be sure your son has been seen by a neurologist experienced in movement disorders. There's no substitute for having seen a particular behavior before, and a movement disorders specialist gets lots of practice with dystonias, tremors, and cerebellar diseases.
As you know, this information is provided for your medical education, and we can't provide actual medical advice. We are available at 800 223-2273 (ask for neurology appointments at 4-5559) if you wish to make an appointment for evaluation. However, Chicago is a major city with excellent medical expertise available (including movement disorders), so you probably don't have to travel. I hope this hleps. CCF MD mdf.
