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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.
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
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.
NCV studies confirmed sensory neuropathy (damage to nerves of both feet).
Putting everything together, vitamin B12 deficiency is the most likely cause.
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
*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
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