Uncontrollable Shaking: A Sign Of Stroke?

Strokes can cause movement disorders, including uncontrollable shaking. These are known as post-stroke movement disorders, and they can appear either acutely or as a delayed symptom. Involuntary abnormal movements have been reported after ischaemic and haemorrhagic strokes.

Post-stroke movement disorders can be hyperkinetic or hypokinetic. Hyperkinetic movement disorders include hemichorea-hemiballism, dystonia, tremor, myoclonus, and parkinsonism. Hypokinetic movement disorders include akinesia and rigidity.

The frequency of post-stroke abnormal movements is unclear, with studies reporting that 1-4% of stroke patients develop movement disorders. The time course for the development of movement disorders varies, from the day of the stroke to several years later.

Treatment for post-stroke movement disorders includes medication, rehabilitation therapies, and in severe cases, surgical interventions such as deep brain stimulation.

Tremors can be categorised as either action or rest tremors

Action tremors are the most common type of tremor after a stroke, but some survivors may experience resting tremors or a combination of both types. The hands and arms are often affected, but tremors after a stroke may also occur in the legs, head, or even the soft palate of the mouth.

Action tremors can be further categorised as postural, kinetic, or intention tremors

Action tremors are those that occur during voluntary movement. They can be further categorised as postural, kinetic, or intention tremors.

Postural tremors occur when the body is voluntarily held in place against gravity. Kinetic tremors occur during voluntary movement. Intention tremors occur when tremors increase in intensity as one gets closer to a target, such as while reaching for a cup.

Action tremors are most common after a stroke, but some survivors may experience resting tremors or a combination of both types. While the hands and arms are often affected, tremors after a stroke may affect various areas of the body, including the arms, hands, legs, head, or even the soft palate of the mouth.

While many secondary effects of stroke occur within minutes to hours after the incident, tremors often have a delayed onset. Of all the post-stroke movement disorders, tremors have the longest delayed onset, occurring anywhere from one month to four years after the stroke.

Resting tremors are most common in people with Parkinson's disease

Resting tremors are a common symptom of Parkinson's disease, occurring in about 70-90% of people with the disease. They are characterised by rhythmic, involuntary shaking movements that occur when the body is at rest. The tremors typically affect the hands and are often described as a "pill-rolling" motion. They can also occur in other parts of the body, such as the legs, jaw, or tongue. Resting tremors usually start on one side of the body and may worsen with fatigue, stress, or intense emotions.

While resting tremors are most common in Parkinson's disease, they can also occur due to other conditions, such as essential tremor or multiple sclerosis. Additionally, resting tremors can be a secondary effect of a stroke, usually caused by damage to the thalamus or basal ganglia in the brain. However, tremors after a stroke often have a delayed onset and are relatively uncommon.

Asterixis, or hand flapping tremor, is associated with stroke

Asterixis, or hand flapping tremor, is a movement disorder that can occur when something in the brain and supportive nervous system is not working properly. It is characterised by an inability to maintain a position, which is demonstrated by jerking movements of the outstretched hands when bent upward at the wrist. This movement can resemble the flapping of a bird's wings.

Asterixis is associated with stroke, as well as other diseases of the brain and body. It is caused by an abnormal function of the diencephalic motor centres in the brain, which regulate the muscles involved in maintaining position. It is also associated with various encephalopathies, especially those due to faulty metabolism.

Asterixis is normally asymptomatic and found during clinical examination for other reasons, but more rarely it can be the leading symptom. It is typically bilateral, but may be asymmetric. Unilateral asterixis may occur with structural brain disease, such as a stroke.

Parkinsonian tremor is a common early sign of Parkinson's disease

The tremor is usually a "resting tremor", which means it occurs mostly at rest and lessens during sleep and when the affected body part is actively in use. However, about 50% of patients with Parkinson's disease may also present with a tremor that occurs with arms stretched outward.

Tremor is often the first motor symptom of Parkinson's disease and can be one of its most troublesome symptoms. It is estimated that about 70-90% of people with Parkinson's experience a tremor at some point in their lives, and it tends to be slightly less common in younger people with the disease.

While tremor is a common symptom of Parkinson's, it can also be a symptom of other conditions, most notably essential tremor. The main difference between a Parkinsonian tremor and most other types of tremor is that the former is usually a resting tremor, while the latter is usually an "action tremor" that tends to lessen at rest and increase during intentional movement or stress.

Frequently asked questions