A 31-Year-Old Woman With Right Arm Tremors

Heidi Moawad, MD

Disclosures

May 01, 2019

Physical Examination and Workup

Upon physical examination, the patient is alert, oriented, and cooperative and does not appear to be in distress. Her affect is normal, and her memory and cognitive functioning is normal.

She does not have any rashes, lesions, or discoloration. Her pulse is regular, and her respiratory, cardiac, and abdominal examinations are unremarkable. 

She does not have any facial asymmetry. Her extraocular movements are full, and she does not have diplopia. She has saccades in both eyes when looking toward the right and left, but not while at rest. Her pupils are equal, round, and reactive to light. 

Her language and speech are coherent and fluent without any defects. Her strength is slightly decreased in the right biceps and triceps. Otherwise, her motor strength is 5/5, including her right hand. She did not have tremors or involuntary movements during the physical examination. 

Her muscle tone is slightly diminished in her right upper extremity and is otherwise normal. Her reflexes are normal, with the exception of slightly brisk reflexes in the right upper extremity. Her coordination is impaired. She demonstrates dysmetria on finger-to-nose testing when using her right hand, but her left hand is normal. Similarly, rapid alternating movement test results are slow and imprecise when using her right hand, but normal when using her left hand. Her sensory examination is normal to light touch, pinprick, vibration, position, and temperature. Her gait is normal, and she can do a tandem walk without difficulty.

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