Acutely shaky hand

Clinical introduction A 57-year-old man presented acutely with involuntary movements of his left hand. He had hypertension, chronic kidney disease and chronic obstructive pulmonary disease. These movements were best described as sudden, recurrent and arrhythmic loss of tone and power of the left wrist and fingers (video 1). They were most prominent when extending the left wrist, but were absent when the arms were at rest and were not elsewhere. There were no additional neurological deficits. Serum urea, ammonia, sodium, potassium, calcium, magnesium, phosphate and glucose levels were normal. His haematological profile, infective markers and thyroid function were unremarkable. Question Which best describes his involuntary movements? Focal tremors Focal dystonia Unilateral athetosis Unilateral asterixis Answer: D While the other options also involve involuntary movements, their individual characteristics are incongruent with the patient’s signs: (A) tremors are rhythmic oscillations...
Source: Emergency Medicine Journal - Category: Emergency Medicine Authors: Tags: EMJ Image Challenge Source Type: research