Can essential tremor cause post-micturition dribble and a diminished sense of smell?

Question

Hi doctor,

I am a 28 year old male who was diagnosed with essential tremor six years ago. Presently, I have tremors only in my right hand and thumb, but it feels like my entire body wants to move. Before, I used to get tremors on some movement, but nowadays, it is present even while at rest. I am also getting muscle twitches in my left bicep on and off. Occasionally my voice gets low and shaky, and I struggle with words. I am currently taking Bisoprolol, Amlodipine and Ramipril. I have noticed my sense of smell is diminishing quite rapidly, though I do not have a cold or flu. I do not know if this is related, but I also have stiff upper back and neck, which gets worse in the mornings. I have nightmares which are affecting my sleep, although this could be due to my depression and anxiety. I also have post-micturition dribble, which is embarrassing. I seem to be choking on my saliva or when I have a drink on a daily basis now. Please help as my symptoms are getting worse.

Answer 1

Hi,

Welcome to icliniq.com.

Based on the history which you have provided, it seems to be a progressive neurological condition. Essential tremor is diagnosed when there is no pathology in the brain, and the cause is idiopathic or unknown. But in your case, it is a bit of concern as you have developed urine symptoms. Usually, urine symptoms do not appear in functional or anxiety disorder. There has to be some organic pathology, and you need to get a neurological examination done by an expert neurologist.Investigations to be done are as follows. Contrast-enhanced MRI of the brain, Thyroid profile, Vitamin B12 level, Nerve conduction velocity, Electromyography. The differential diagnoses are,Frontal lobe pathology, Vitamin B12 deficiency, Multiple cranial nerve involvement, Peripheral neuropathy.

Answer 2

Hi,

Welcome back to icliniq.com.

Loss of sense of smell and tremors are present in Parkinson's disease, but the other essential criteria for diagnosis are bradykinesia and hypokinesia which means slowing of movement initiation. Do not worry for now. Let us discuss this after your neurological examination and tests.