Neurology Q12

A 41-year-old woman is evaluated for a 2-year history of tremor in the dominant right hand. She says that the tremor has begun interfering with her work as a hairdresser, especially when she uses scissors. She also reports tightness in the forearm. The patient is able to eat, write, and type without difficulty and has had no trauma, imbalance, slowness of movement, or change in gait speed. Alcohol has no effect on the tremor. There is no family history of tremor.

On physical examination, vital signs are normal. A right upper extremity tremor is noted, as are rhythmic flexion of the wrist, involuntary flexion of the fingers, and pronation of the forearm. The tremor is present both at rest and during action and resolves by changing the position of an outstretched arm. No dysmetria, dysdiadochokinesia, bradykinesia, rigidity, shuffling gait, or reduced arm swing is noted. Her handwriting is neither tremulous nor micrographic.

An MRI of the brain is unremarkable.

Which of the following is the most likely diagnosis?

Rubral tremor
 

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