In addition to the classic postural tremor associated with alcohol withdrawal, other movement disorders can occur in the setting of alcohol abuse and withdrawal. '104' A rare, slow tremor of the lower extremities can also occur in alcoholics and is produced by the synchronous flexion- extension of the muscles of the hip girdle. yj This 3-Hz tremor is associated with alcoholic cerebellar degeneration affecting the anterior superior vermis and cerebellar hemispheres. '106' When they are supine, patients with this form of tremor may reveal a kicking movement when the legs are elevated and the knee and hip joints are flexed 90 degrees. It can be best observed when the patient stands with the feet together and the knees partially bent. This results in a slow up and down movement of the body.
Transient parkinsonism may rarely appear in the setting of alcohol abuse or withdrawal in patients with no liver dysfunction. '107] , '108 This typically occurs a few days after alcohol cessation and is characterized by bradykinesia, stooped posture, and a coarse resting tremor in the hands. Cogwheel rigidity of the limbs can also be appreciated. These episodes may occur during alcohol withdrawal. These signs may last for a few weeks or months, yet they do not persist. Transient dyskinesias with lingual-oral, neck, or limb movements have been reported in some alcoholics. '109 , 'rd
With chronic abuse of alcohol, hepatic inflammation and fibrosis can occur and may be associated with encephalopathy. In this setting, patients have an altered level of consciousness with diffuse slowing and at times triphasic waves on an EEG. Asterixis, or so-called negative myoclonus, is a classic finding in these patients and is characterized by clusters of brief irregular lapses of sustained posture. '111 , '118 On examination, this may be best demonstrated by asking the patient to hold out his or her upper extremities and extend the hands at the wrist. The involuntary lapses in posture are associated with 50- to 200-msec periods of electrical silence in muscles that are tonically active. The mechanisms of this movement are unknown. Chronic or persistent choreiform movements may also occur with alcoholic liver disease. W
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