PT  - JOURNAL ARTICLE
AU  - Wilson KW Fung
AU  - Alfonso Fasano
TI  - "Stretched Slinky" Sign: Another Clue to Functional Tremor
AID  - 10.1212/CPJ.0000000000200075
DP  - 2022 Aug 31
TA  - Neurology: Clinical Practice
PG  - 10.1212/CPJ.0000000000200075
4099  - http://cp.neurology.org/content/early/2022/08/31/CPJ.0000000000200075.short
4100  - http://cp.neurology.org/content/early/2022/08/31/CPJ.0000000000200075.full
AB  - Introduction: Functional tremor is the most common functional movement disorder, although its diagnosis can be challenging. Archimedes spiral drawings can be helpful in eliciting additional signs associated with tremor. Here, we present examples of an unusual looping of Archimedes spirals only seen in functional tremor, which has not been reported previously.Methods: Clinical information regarding demographic data, clinical history and examination findings (including Archimedes spiral drawings) and investigation results of patients with functional tremor in the Movement Disorders clinic were reviewed.Results: Three paradigmatic patients with functional tremor demonstrated a unique‘looping’appearance of Archimedes spiral drawings,akin to the appearance of a stretched slinky. The degree of randomness of the spirals varied from patient-to-patient and often mirrored tremor severity, regardless of the diagnosis.Conclusion: The clinical hallmarks of a functional tremor include the variable combination of positive signs, such as inconsistency (variability and distractibility), incongruence with known tremor syndromes, entrainment and co-activation although these findings might not always be present. We describe a unique appearance of spiral drawings (looping), which could add as another clinical sign for functional tremor.