Essential Tremor in a Young Adult with Family History

Case at a Glance

A 22-year-old male presents with bilateral hand tremor that occurs during activity and at rest, with a significant family history of hand tremor in his father.

Patient's Story

The patient reports that his hands are never completely still and exhibit slight trembling continuously. He notices the tremor particularly when writing or performing fine motor tasks. The patient expresses concern about the tremor being an early sign of Parkinson's disease. His father has a significant hand tremor that is present even when not holding objects, suggesting a possible hereditary component.

Initial Assessment

Physical examination would reveal bilateral hand tremor present both at rest and during action. The tremor appears to be symmetrical and involves fine motor activities. Family history is significant for paternal hand tremor, suggesting possible genetic predisposition to essential tremor.

The Diagnostic Journey

The clinical presentation and family history point away from Parkinson's disease, as Parkinson's tremor is typically unilateral at onset and primarily occurs at rest. The bilateral nature, action component, and positive family history are more consistent with essential tremor or enhanced physiological tremor.

Final Diagnosis

Essential tremor with positive family history, ruling out Parkinson's disease based on clinical presentation and tremor characteristics.

Treatment Plan

Patient education about the benign nature of essential tremor. Reassurance that this condition is not dangerous and commonly has a genetic component. Recommendation for in-person neurological evaluation if symptoms worsen or become functionally limiting. Discussion of potential treatment options if tremor becomes more bothersome in the future.

Outcome and Follow-up

Patient was reassured about the benign nature of the condition. Long-term monitoring recommended, with return if tremor significantly worsens or impacts daily activities. Emphasis placed on the fact that slowly progressive or stable tremors over years are typically less concerning than rapidly developing neurological symptoms.