[Orthostatic tremor]

Abstract

Background: Orthostatic tremor is a rare disease characterized by difficulty with standing still. Patients often undergo a long diagnostic search and often feel underrecognized, partly due to unfamiliarity of physicians with the disease.

Case description: We report a 72-year-old male experiencing difficulty in standing still, accompanied by a tingling, trembling and painful sensation in the legs, over the last ten years. Several orthopedic and neurological causes had been suspected until neurological examination revealed a 'helicopter sign' upon auscultation of the leg muscles. Tremor registration showed a 14 Hz tremor in the legs upon standing, confirming the diagnosis of orthostatic tremor. There was moderate improvement with pharmacological treatment.

Conclusion: Orthostatic tremor should be suspected in patients with instability or atypical symptoms upon standing. A neurological referral including tremor registration is recommended in these cases.