Wing beating tremor in Wilson’s disease
by Kalyan B Bhattacharyya, Kalyan Satish V

Atlas of Neurology—A Case-based Approach

by Satish V Khadilkar, Kalyan B Bhattacharyya
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This low frequency high amplitude posture induced proximal arm tremor elicited by sustained abduction of the arms with flexed elbows and palms facing downwards, is characteristic of Wilson’s disease. It is the combination of rest, action, and postural tremor and is associated with lesions in the dentatorubrothalamic pathway, involving mostly the superior cerebellar peduncle. It is seen in patients with multiple sclerosis, tumors, or stroke. More recently, it is thought to be due to lesions in the nigrostriatal pathway. Previously it was known as rubral tremor or Holmes’ tremor after Gordon Holmes of Queen Square, London, who described it in 1904.

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