G-3933

Wing-Beating Tremor as the Initial Manifestation of Multiple Sclerosis: A Diagnostic Pitfall in a Patient with Psychiatric History

 Marzie Abutorabi-zarchi ¹, Seyedeh Fatemeh Asgary ², Arezou Ashtari ² © ℗   

 
Abstract

Introduction: Tremor is a frequent neurological complaint with diverse etiologies. In patients with psychiatric disorders, it is often misattributed to medications. However, tremor characteristics—such as asymmetry and its pattern ( rest ,action or wing-beating) —can provide diagnostic clues. Case Presentation: We report a 39-year-old woman with a history of psychiatric treatment (haloperidol and citalopram), who presented with a persistent left upper limb tremor for one year, initially misdiagnosed as drug-induced. The tremor had a rest postural wing-beating component. One week prior to neurology referral, she developed gait disturbance. Neurological examination revealed abnormal heel to shin and finger to nose in left side ,gait ataxia ,generalized hyperreflexia and bilateral Babinski and Huffman's sing . MRI demonstrated demyelinating lesions consistent with multiple sclerosis (MS). She responded favorably to corticosteroid pulse therapy, ocrelizumab, and primidone. After six months, her ataxia and tremor significantly improved. Results: Not all tremors in psychiatric patients are drug-induced. Wing-beating tremor warrants thorough evaluation and may indicate underlying demyelinating disease.

Keywords: Multiple Sclerosis,Wing-Beating Tremor,Drug-Induced Tremor,Cerebellar Signs,Tremor Differential