Fekete Robert, Li Jin
Department of Neurology, New York Medical College, New York.
Clin Med Insights Case Rep. 2013 Apr 29;6:67-74. doi: 10.4137/CMCRep.S11903. Print 2013.
We present clinical features and tremor characterization in a patient with Parkinson's disease (PD) as well as in two cases of essential tremor (ET) with some parkinsonian features but no evidence of dopaminergic terminal loss on (123)I-FP-CIT Single Photon Emission Computed Tomography (SPECT). Relatively slow frequency rest tremor and bilateral upper extremity bradykinesia without decrementing amplitude were observed in the ET cases, with unilaterally decreased arm swing in case 3. Alternating rest tremor and re-emergent tremor with 13 second latency was confirmed in the PD case. Re-emergent tremor had alternating characteristics, which to our knowledge has not been previously reported. The ET cases had synchronous postural tremor. Alternating re-emergent tremor in PD provides further evidence for re-emergent tremor as an analogue of rest tremor in PD. Two cases of ET with synchronous postural tremor and one to two year history of parkinsonian features had no evidence of dopaminergic terminal loss up to 40 years after the initial onset of ET. Tremor synchronicity characterization can assist in differential diagnosis between the two disorders.
我们展示了一名帕金森病（PD）患者以及两例具有一些帕金森病特征但在（123）I-FP-CIT单光子发射计算机断层扫描（SPECT）上无多巴胺能终末丢失证据的特发性震颤（ET）患者的临床特征和震颤特征。在ET病例中观察到相对缓慢频率的静止性震颤和双侧上肢运动迟缓且幅度无递减，病例3存在单侧摆臂减少。在PD病例中证实了交替性静止性震颤和潜伏期为13秒的再发性震颤。据我们所知，再发性震颤具有交替特征，此前尚未有报道。ET病例存在同步性姿势性震颤。PD中的交替性再发性震颤为再发性震颤作为PD中静止性震颤的类似物提供了进一步证据。两例具有同步性姿势性震颤且有一到两年帕金森病特征病史的ET患者，在ET首次发病后长达40年都没有多巴胺能终末丢失的证据。震颤同步性特征有助于这两种疾病的鉴别诊断。
