Functional parkinsonism with tremor and slowed gait

This 82-year-old woman began to shake suddenly in both hands and feet, right more than left, about 1.5 years before our initial evaluation. The shaking has occurred intermittently since that time, having tremor-free intervals of several weeks. She also has a “cautious gait” associated with a fear of falling. Examination shows an intermittent, easily suppressible and distractible tremor of variable frequency and amplitude not consistent with organic disease. MRI showed left parasagittal meningioma, shown on the video. After only 1 tablet of alprazolam, her tremor completely stopped and has not recurred for 2 years. Although initially attributed to the parasagittal tumor, the clinical features and response to treatment strongly indicate that the tremor is not organic. About 3% of elderly women have asymptomatic meningiomas. (Contributed by Dr. Joseph Jankovic.)