Trembling 2

A 29-year-old woman presents with a history of tremors for 3 months.

She initially experienced a mild tremor of her right hand when holding objects, which progressed to involve her left arm, head, and both legs. A day ago, the tremors started appearing at rest, which finally prompted her to seek medical advice.

On close questioning, she admits to feeling depressed and anxious for the past couple of months. She attributes this to her fear that the tremors might be due to an underlying serious illness.

Her medical history is unremarkable, and there is no history of psychiatric disease. She is not on any medications and has no history of recreational drug use.

Select Relevant Investigations
Liver Profile

Performed

ALT: 200 IU/L (10-35)
AST: 150 IU/L (<35)
ALP: 300 IU/L (44-147)
Total Bilirubin: 1.5 mg/dL (0.3-1)
Albumin: 2 g/dL (3.5-5)
INR: 1.1 (0.9-1.1)
Slit-Lamp Examination

Performed

Kayser-Fleischer (KF) rings are seen in the superior corneal poles.
Serum Ceruloplasmin

Performed

Serum Ceruloplasmin: 8 mg/dL (20-40)
MRI Brain

Performed

The T2 weighted images reveal basal ganglial hyperintensities, and a "face of the giant panda" sign.

Select Relevant Management
Penicillamine
Screen Family Members
Corticosteroids
Zinc Therapy