Thread by @theneurolander

Wing-beating tremor!!!

“pseudosclerotic, parkinsonism, and dystonic/choreic forms of Wilson’s disease”

American-born British neurologist Samuel Alexander Kinnier Wilson (1878–1937)

#MedTwitter #neurotwitter #EndNeurophobia #tweetorials

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Pathophysiology

“lesion in the dentatorubrothalamic pathway”

- cerebellar outflow pathway

Complex phenomenology
- dystonic, myoclonic, rhythmic tremor?


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Definition

“low-frequency, high-amplitude, posture-induced proximal arm tremor, elicited by sustained abduction of the arms, with flexed elbows and palms facing downward”

- postural tremor
- wing-beating posture

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Wing-beating tremor – features

- low frequency & high amplitude
> inc amplitude w/ inc duration of posture holding

- posture-induced
- proximal arm tremor

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Wing-beating tremor: Wilson's disease

- low frequency & high amplitude
- posture-induced
- proximal arm tremor

doi.org/10.1056/nejmic… via: NEJM

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Wing-beating tremor: Wilson's disease

- low frequency & high amplitude
- posture-induced
- proximal arm tremor
💡double panda sign

doi.org/10.1002%2Fmdc3… via: Mov Disord Clin Pract

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Wing-beating tremor: Creutzfeldt-Jakob Disease

- low frequency & high amplitude
- posture-induced
- proximal arm tremor
💡myoclonus?

doi.org/10.1001/jamane… via: JAMA Neurol

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Wing-beating tremor: Wilson's disease

- low frequency & high amplitude
- posture-induced
- proximal arm tremor
💡zolpidem-responsive

doi.org/10.1002%2Fmdc3… via: Mov Disord Clin Pract

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Wing-beating tremor: Wilson's disease

- low frequency & high amplitude
- posture-induced
- proximal arm tremor
💡after liver transplantation

doi.org/10.1016/j.jocn… via: Journal of Clinical Neuroscience

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Wing-beating tremor: Wilson's disease

- low frequency & high amplitude
- posture-induced
- proximal arm tremor

doi.org/10.1007/978-1-… via: Movement Disorders: A Video Atlas

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Wing-beating tremor: Wilson's disease

- low frequency & high amplitude
- posture-induced
- proximal arm tremor
💡dimercaprol-responsive

doi.org/10.4103%2F0972… via: Ann Indian Acad Neurol

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Wing-beating tremor: Wilson's disease

- low frequency & high amplitude
- posture-induced
- proximal arm tremor
💡 Face of a Giant Panda

doi.org/10.7759/cureus… via: Cureus

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Wing-beating tremor: Wilson's disease

- low frequency & high amplitude
- posture-induced
- proximal arm tremor

doi.org/10.1016/j.ncl.… via: Neurologic Clinics

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Wing-beating tremor: Wilson's disease

- low frequency & high amplitude
- posture-induced
- proximal arm tremor

via: Neurology Made Interesting

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Wing-beating tremor: Wilson's disease

- low frequency & high amplitude
- posture-induced
- proximal arm tremor

via: Neurology Made Interesting

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Wing-beating tremor: Wilson's disease

- low frequency & high amplitude
- posture-induced
- proximal arm tremor

via: Dr Zubin Sharma

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Wing-beating tremor: Wilson's disease

- low frequency & high amplitude
- posture-induced
- proximal arm tremor

via: Kaveh Shafiei

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Wing-beating tremor: Wilson's disease

- low frequency & high amplitude
- posture-induced
- proximal arm tremor

via: Prakash Harischandra

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Wing-beating tremor: Wilson's disease

- low frequency & high amplitude
- posture-induced
- proximal arm tremor

via: Dr. Waqas Khan

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Wing-beating tremor: Wilson's disease

- low frequency & high amplitude
- posture-induced
- proximal arm tremor

via: Dr.Syed Raza Hussain

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“We don't always observe true 'wing beating tremor' like Kinnier Wilson described, however when we see it; it can be dramatic”

@MichaelOkun @VUMCneurology


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