Hand Tremors in a 46-Year-Old Woman: Differential Diagnosis

Hand tremor in a healthy 46-year-old woman has several potential causes:

• Essential tremor: Most common; bilateral, action/postural; autosomal dominant often; alcohol-responsive.
• Anxiety/stress: Transient, situational.
• Medication-induced: Stimulants, antidepressants (SSRIs), lithium, valproate, bronchodilators, antipsychotics.
• Caffeine/nicotine excess.
• Hypoglycemia: If diabetic; check glucose.
• Thyroid dysfunction: Hyperthyroidism (fine tremor); hypothyroidism (coarse).
• Vitamin B12 deficiency: Neuropathic tremor.
• Parkinson's disease: Resting tremor, bradykinesia, rigidity; less likely at 46 but possible (young-onset).
• Multiple sclerosis, Wilson's disease, cerebellar disorders.

Evaluation: Neurologic exam, TSH, B12, glucose, medication review, possibly DaTscan or MRI. Treatment targets cause (e.g., propranolol/primidone for essential tremor).