Wing-Beating Tremor
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An 18-year-old man presented with a tremor in the right arm that had begun 2 years earlier and had progressed to involve the other arm, the head and the legs. Neurologic examination revealed dysarthria, generalized hypertonia and a “wing-beating” tremor (Panel A).This low-frequency, high-amplitude, posture-induced proximal arm tremor, elicited by sustained abduction of the arms, with flexed elbows and palms facing downward is characteristic of Wilson's disease.The presence of Kayser–Fleischer rings in both eyes (Panel B), a low serum ceruloplasmin level (77 U per liter; reference range, 200 to 1100), ultrasonographic evidence of chronic liver disease and computed tomographic evidence of hypodensities in the lentiform nuclei bilaterally, the thalamus and the midbrain were all consistent with a diagnosis of Wilson's disease...

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