What Happens During a Neurological Examination for Tremors?

What Happens During a Neurological Examination for Tremors?

Shaky hands can sometimes be very concerning, especially when the symptoms become frequent. Tremors are also noticed when you are writing, holding a cup, executing other tasks or when you are at rest. Tremors aren’t always due to stress or fatigue. They sometimes can be due to a neurological condition.

When tremors disrupt a person’s daily activity, a doctor can request a neurological examination. The thought of a neurological examination may be new to the patient and unnerving, but it doesn’t have to be. It is actually a very simple and important step in figuring out what is going on with the patient.

Neurological examinations allow the doctor to assess the Nervous System, muscle control, coordination, and movement. It is also critical in determining whether the patient is experiencing essential tremor, Parkinson’s disease, multiple sclerosis and other movement disorders.

An Overview of Tremors

Involuntary and rhythmic shaking movements are referred to as tremors. The regions in the body that are mainly associated with tremors are the arms, hands, head, and voice. Tremors can actually be associated with other parts of the body, such as the arms and hands. Tremors can also be present when the body is at rest or during an activity. Tremors can also be triggered by stress.

Tremors can be very severe and cause disruptions in a person’s daily activities.

Tremors And Their Associated Symptoms

Tremors are associated with a lot of other symptoms, such as:

• Difficulty in writing, eating and other activities due to unstable hands.
• Difficulty in holding objects.
• Tremors and shaking during an activity.
• Shaking of the head.
• Voice that is shaking.
• Tremors and shaking that disrupt the activity.
• Difficulty in standing and maintaining a steady posture.
• Coordination is also disrupted in a person who is experiencing tremors.

Symptoms can get more severe with increased stress, anxiety, fatigue and caffeine.

The Importance of a Neurological Examination

When trying to determine the cause of tremors, one of the many functions of a neurological examination is to help determine if the tremors are caused by a nervous system disorder related to a neurological issue.

Since different tremors can have different underlying causes, the examination can help a physician determine:

• The type of tremor
• The severity of the tremor
• The extent of the nervous system
• Possible brain or nerve involvement

This examination can help the physician determine what other tests and what types of treatment may be appropriate.

How is a Neurological Examination Performed?

Prior to the actual examination, the physician gathers detailed information concerning the symptoms and the patient’s medical history.

Some of the questions that may be asked are:

• When did the tremors first appear?
• Do the tremors occur when at rest or when moving?
• Are the tremors becoming worse?
• Do other family members of the patient have tremors?
• Do the tremors worsen when the patient is under stress or has consumed caffeine?
• Do the tremors affect the patient’s balance and ability to walk?
• Is the patient currently taking any medications?

All of this information helps the physician narrow the focus to a likely cause.

Observation of Tremors

The first step in a neurological examination is usually the observation of tremors.

During this part of the examination, the physician may ask the patient to do one or more of the following:

• Place their hands on their lap
• Extend their hands straight out
• Hold a cup or other object
• Write or draw

This step helps the physician determine:

• If the tremors are present when at rest or if they are action-induced
• The specific body part(s) that are affected by tremors
• The action of the tremors
• The severity of the tremor

The presence of different tremor actions and severity can help the physician determine the presence of different neurological disorders.

Testing Muscle Strength and Tone

Part of the neurological examination is testing the patient for muscle strength. To do this, the physician may ask the patient to either push or pull against something that the physician is holding.

Assessing muscle tone can reveal information about:

• Rigidity
• Stiffness
• Weakness

For example, rigidity of the muscles is often associated with Parkinson’s disease.

Tests of Coordination and Balance

Tremors may affect coordination and balance.

Tests can include:

• Touching the finger to the nose
• Walking in a straight line
• Standing still with the eyes closed
• Making swift movements with the hands

These tests provide information about the brain and the nervous system’s control of movements.

Tests of Reflex Action

Reflexes are tested by using a rubber hammer to strike the knee, the elbow, and other parts.

This tells the doctors how the spinal cord and the nerves are functioning.

Unusual reflexes can indicate a problem with the brain or the nervous system.

Testing Walking and Posture

The neurologist can see how the patient walks.

The neurologist looks for:

• Movement that is slow
• Walking with small steps and shuffling
• Unusual movement of the arms
• Problems with maintaining balance
• Stooped posture

All of these can be important findings when looking for the presence of Parkinson’s disease.

Tests That Are Done After the Examination

A neurological examination may be sufficient to arrive at a diagnosis for some tremor disorders, but other tests are generally done to exclude other disorders.

Blood Tests

Blood tests can look for:

• Thyroid disorders
• Vitamin deficiencies
• Disorders of metabolism
• Liver disease
• Kidney disease

Brain Imaging

Brain scans using MRI or CT technology may be done to exclude:

• Stroke
• Injury to the brain
• Tumors
• Multiple sclerosis

Other Special Tests of Neurology

For an accurate diagnosis, some highly specialized tests for disorders of movement can be done.

Common Diagnoses from a Neurological Exam

A neurological exam can help in the identification of a number of disorders associated with tremors. These disorders are:

Essential Tremor

This tends to cause tremors as the patient undertakes a movement.

Parkinson’s Disease

This can cause tremors when the patient is at rest, as well as body stiffness and slowness.

Multiple Sclerosis

This can produce tremors as well as body weakness, numbness, and visual disturbances.

Medication-Induced Tremors

Some medications can cause tremors as a side effect.

Is the Exam Painful?

More often than not, a neurological exam is non painful as it involves a physical movement, and the health care worker is merely an observer. Some patients are quite nervous prior to these types of exams, but once they have undergone the exam, they realize how simple and unpainful the entire process is.

How Long Does a Neurological Exam Take?

Typically, the entire exam process can take from 20 minutes to 45 minutes, and this is purely based on how complex the symptoms are, as well as how many later diagnostic tests will be required.

Successive Treatments After Diagnosis

Successive treatment of tremors is purely based on the cause of the tremors. This can include:

• Changing some habits
• Managing stress
• Prescriptive medications
• Physical therapy
• Occupational therapy
• Even in more severe cases, Deep Brain Stimulation (DBS) or MR-guided Focused Ultrasound

When treating tremors, the earlier the diagnosis is made, the better it is for the patient.

Final Thoughts

When patients with tremors request a neurological exam, it is because they want to know the cause of their tremors and if the cause is related to some form of neurological disorder. Tremors undoubtedly cause a lack of patient safety, which is why the neurological exam for the patient is non painful. Tremors that are long-term and have no known cause should not be taken lightly by a patient, especially when the presence of these tremors has progressed. If a patient is suddenly unable to undertake their normal daily routine because of newly developed tremors, then this means that the patient should seek a diagnosis as a priority to know the cause of the tremors and what can be done to treat the tremors long-term.

FAQs

1. What does a neurologist look for when examining a tremor?
They check movement and coordination, as well as balance, reflexes, muscle strength, posture, and the pattern of your tremors.

2. Is a neurological exam painful?
No, there is nothing painful about a neurological exam. It’s mostly done with physical tests and observations, and of course, these are non invasive.

3. Can you diagnose tremors without a brain scan?
Tremors can usually be diagnosed with a medical and family history as well as a neurological exam, but imaging can be done if the doctor is concerned about other issues.