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振戦鑑別のためのフローチャート(2)

フローチャートに従って器質性振戦の鑑別を行う。
出典
imgimg
1: Differentiation and diagnosis of tremor.
著者: Paul Crawford, Ethan E Zimmerman
雑誌名: Am Fam Physician. 2011 Mar 15;83(6):697-702.
Abstract/Text: Tremor, an involuntary, rhythmic, oscillatory movement of a body part, is the most common movement disorder encountered in clinical practice. Rest tremors occur in a body part that is relaxed and completely supported against gravity. Action tremors occur with voluntary contraction of a muscle and can be further subdivided into postural, isometric, and kinetic tremors. All persons have low-amplitude, high-frequency physiologic tremors at rest and during action that are not reported as symptomatic. The most common pathologic tremor is essential tremor. In one-half of cases, it is transmitted in an autosomal dominant fashion, and it affects 0.4 to 6 percent of the population. More than 70 percent of patients with Parkinson disease have tremor as the presenting feature. This tremor is typically asymmetric, occurs at rest, and becomes less prominent with voluntary movement. Features consistent with psychogenic tremor are abrupt onset, spontaneous remission, changing tremor characteristics, and extinction with distraction. Other types of tremor are cerebellar, dystonic, drug- or metabolic-induced, and orthostatic. The first step in the evaluation of a patient with tremor is to categorize the tremor based on its activation condition, topographic distribution, and frequency. The diagnosis of tremor is based on clinical information obtained from a thorough history and physical examination. For particularly difficult cases, single-photon emission computed tomography to visualize the integrity of the dopaminergic pathways in the brain may be useful to diagnose Parkinson disease.
Am Fam Physician. 2011 Mar 15;83(6):697-702.

広義の動作時振戦のイメージ

a:姿勢時振戦(このような姿勢で指先に生じる。一定の姿勢を保つときに激しく振戦を生じる場合がある)
b:動作時振戦(狭義の)または運動時振戦
c:企図振戦(動作時/運動時振戦の中で、特に目標に向かうとき増強するもの)
出典
img
1: 高橋裕秀先生ご提供

振戦鑑別のためのフローチャート(1)

まず生理的な振戦を鑑別し、その後、薬剤性、心因性、代謝内分泌性の振戦の鑑別を行う。
[ID0702]:振戦鑑別のためのフローチャート(2)
出典
imgimg
1: Differentiation and diagnosis of tremor.
著者: Paul Crawford, Ethan E Zimmerman
雑誌名: Am Fam Physician. 2011 Mar 15;83(6):697-702.
Abstract/Text: Tremor, an involuntary, rhythmic, oscillatory movement of a body part, is the most common movement disorder encountered in clinical practice. Rest tremors occur in a body part that is relaxed and completely supported against gravity. Action tremors occur with voluntary contraction of a muscle and can be further subdivided into postural, isometric, and kinetic tremors. All persons have low-amplitude, high-frequency physiologic tremors at rest and during action that are not reported as symptomatic. The most common pathologic tremor is essential tremor. In one-half of cases, it is transmitted in an autosomal dominant fashion, and it affects 0.4 to 6 percent of the population. More than 70 percent of patients with Parkinson disease have tremor as the presenting feature. This tremor is typically asymmetric, occurs at rest, and becomes less prominent with voluntary movement. Features consistent with psychogenic tremor are abrupt onset, spontaneous remission, changing tremor characteristics, and extinction with distraction. Other types of tremor are cerebellar, dystonic, drug- or metabolic-induced, and orthostatic. The first step in the evaluation of a patient with tremor is to categorize the tremor based on its activation condition, topographic distribution, and frequency. The diagnosis of tremor is based on clinical information obtained from a thorough history and physical examination. For particularly difficult cases, single-photon emission computed tomography to visualize the integrity of the dopaminergic pathways in the brain may be useful to diagnose Parkinson disease.
Am Fam Physician. 2011 Mar 15;83(6):697-702.

振戦鑑別のためのフローチャート(2)

フローチャートに従って器質性振戦の鑑別を行う。
出典
imgimg
1: Differentiation and diagnosis of tremor.
著者: Paul Crawford, Ethan E Zimmerman
雑誌名: Am Fam Physician. 2011 Mar 15;83(6):697-702.
Abstract/Text: Tremor, an involuntary, rhythmic, oscillatory movement of a body part, is the most common movement disorder encountered in clinical practice. Rest tremors occur in a body part that is relaxed and completely supported against gravity. Action tremors occur with voluntary contraction of a muscle and can be further subdivided into postural, isometric, and kinetic tremors. All persons have low-amplitude, high-frequency physiologic tremors at rest and during action that are not reported as symptomatic. The most common pathologic tremor is essential tremor. In one-half of cases, it is transmitted in an autosomal dominant fashion, and it affects 0.4 to 6 percent of the population. More than 70 percent of patients with Parkinson disease have tremor as the presenting feature. This tremor is typically asymmetric, occurs at rest, and becomes less prominent with voluntary movement. Features consistent with psychogenic tremor are abrupt onset, spontaneous remission, changing tremor characteristics, and extinction with distraction. Other types of tremor are cerebellar, dystonic, drug- or metabolic-induced, and orthostatic. The first step in the evaluation of a patient with tremor is to categorize the tremor based on its activation condition, topographic distribution, and frequency. The diagnosis of tremor is based on clinical information obtained from a thorough history and physical examination. For particularly difficult cases, single-photon emission computed tomography to visualize the integrity of the dopaminergic pathways in the brain may be useful to diagnose Parkinson disease.
Am Fam Physician. 2011 Mar 15;83(6):697-702.

広義の動作時振戦のイメージ

a:姿勢時振戦(このような姿勢で指先に生じる。一定の姿勢を保つときに激しく振戦を生じる場合がある)
b:動作時振戦(狭義の)または運動時振戦
c:企図振戦(動作時/運動時振戦の中で、特に目標に向かうとき増強するもの)
出典
img
1: 高橋裕秀先生ご提供