The Man With The Shaking Hand
|A 68 yo right-handed retired business executive was referred to your office because of tremor in his right hand. He had been in good health until approximately 6 months before the office visit. Since then he has noticed a tendency for his right hand to shake when he is not paying attention to it. He has no trouble holding a cup of liquid or shaving with a razor, but his hadwriting has become smaller and more difficult for him to produce. He has also noticed trouble getting in and out of his car and in and out of his favorite chair at home. He attributed this to "old age". Another disturbing change has been the appearance of dandruff which has been resistant to frequent shampooing with special shampoos.|
His physical examination is unremarkable except for scaling of his oily, skin expeially around the scalp. His gait is abnormal. He appears stiff and has trouble turning. He tends to trun slowly with small steps. His right arm does not swing. He can get up from a chair by using his hands to pusch off. He cannot get up from a chair with hsi arms crossed in front of his chest. There is a 3-5 Herz, resting tremor of the right hand which the patient can suppress by holding his hand or soing some activity with it. Tapping the space between his eyes results in a continued eyeblink with no adaptive attentuation (Myerson's sign). There is cogwheeling present in the right wrist and some increased tone in the right arm. He has full strength, symmetrical 2+ deep tendon reflexes and normal appreciation of all sensory modalities.