Tremor (cerebellar)

Cerebellar tremor presents as a unilateral or bilateral, low-frequency intention tremor(1).

• is a slow, broad tremor of the extremities (2)
• it occurs at the end of a purposeful movement
• it may be caused by damage to the cerebellum resulting from stroke, brainstem tumor, or multiple sclerosis.
• cerebellar lesions produce kinetic tremor on the ipsilateral side of the body
• finger-to-nose testing results in worsening tremor as the finger approaches the nose.
• it is a 6-8 Hz tremor that is of variable amplitude.

Clinical features include:

• aggravation by change in posture and movement
• terminal accentuation, i.e. worse at end of movement
• relief by rest
• major sites for this tremor are the limbs, trunk and head
• associated features of dysmetria, ataxia and nystagmus

A cerebellar tremor is caused by a lesion of the red nucleus. It may occur as part of Benedikt's syndrome.

Management:

• seek expert advice
• possible medications to treat cerebellar tremors include topiramate and ondansetron (3)

Reference:

• (1) Sharon Smaga. Tremor. Am Fam Physician 2003;68:1545-52,1553
• (2) Tremor fact sheet. National Institute of Neurological Disorders and Stroke National Institutes of Health.2007
• (3) Frei K, Truong DD. Medications used to treat tremors. J Neurol Sci. 2022 Apr 15;435:120194. doi: 10.1016/j.jns.2022.120194. Epub 2022 Feb 19. PMID: 35279634.