Dr Sudhir Kumar MD DM Profile picture
Mar 29 5 tweets 2 min read Twitter logo Read on Twitter
Shaking of hands and burning feet in a middle aged person: look for this treatable cause

1. 56-yr old Mr K presented with shaking of hands for several months, and burning & tingling of feet for 2 weeks. He had been started on trihexyphenidyl for tremors by a neurologist.
2. Clinical examination revealed action (postural) tremors. He had no slowness of moments, rigidity or balance issues.
Tremors were suggestive of essential tremors (ET). Burning feet was suggestive of sensory neuropathy. He had no numbness or weakness of feet.
#Medtwitter
3. Blood tests done earlier showed vitamin B12 deficiency. All meals consumed by Mr K (except 4 meals/month) were vegetarian.
NCV studies confirmed sensory neuropathy (damage to nerves of both feet).
Putting everything together, vitamin B12 deficiency is the most likely cause. ImageImage
4. Take home message
*In patients presenting with sensory neuropathy (burning, tingling or numbness of feet) with or without tremors, rule out vitamin B12 deficiency.
*Early diagnosis and prompt initiation of treatment can result in excellent outcomes.
#VitaminB12 #neurotwitter
5. Further reading
doi.org/10.4103/0028-3…

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Shaking of hands (tremors) in an elderly is not always due to Parkinson's disease

1. 75-year old woman presented with shaking of hands (tremors) for one year. She had difficulty in having food, tea or water due to shaking. She also couldn't properly write or sign.
#MedTwitter
2. She was referred by her physician to rule out Parkinson's disease (PD). Her tremors were postural and absent at rest. She had no slowness of movements, rigidity or postural imbalance.
Clinically, it was more like essential tremors (ET) & not like PD.
I asked for blood tests+
3. to rule out treatable cause of tremors.
Vitamin B12 was very low. She was almost a vegetarian (had non veg food only once a month). Vitamin D was also low.
Vitamin B12 deficiency can cause tremors. Treatment with vitamin B12 supplements can reduce the tremors. Image
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