'Eye of the Tiger' Sign on MRI & Mask-like Facies & Pill Rolling Tremor: Causes & Reasons

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Patient File

Sex unknown, Age unknown

Reported Symptoms

'Eye of the Tiger' Sign on MRI, Mask-like Facies, Pill Rolling Tremor,

Negated

None

Unsure

None

Possible Causes

Juvenile Paralysis Agitans of Hunt

Parkinsonismo precoce associado a lesões palidais de tipo "eye-of-the-tiger" "Eye-of-the-tiger" sign at MRI in a patient with early-onset parkinsonism Egberto Reis Barbosa [scielo.br]

Accession 1 dysarthria 32 HP:0001260 2 gait disturbance 32 HP:0001288 3 tremor 32 HP:0001337 4 abnormality of metabolism/homeostasis 32 HP:0001939 5 dystonia 32 HP:0001332 6 mask-like [malacards.org]

and the movement has been called a “ pill-rolling” tremor. [biotechnologyforums.com]

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Parkinson Disease

facies Expressionless face Lack of facial expression Mask-like facial appearance [ more ] 0000298 Paraparesis Partial paralysis of legs 0002385 Parkinsonism with favorable [rarediseases.info.nih.gov]

People with PD may experience: Tremor, mainly at rest and described as pill rolling tremor in hands. [parkinson.org]

The typical Parkinson’s tremor is “pill-rolling” – it looks like holding a pill between thumb and forefinger and continuously rolling it around. [parkinson.org]

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Parkinson's Disease Type 3

People with PD may experience: Tremor, mainly at rest and described as pill rolling tremor in hands. [parkinson.org]

You may a rub your thumb and forefinger back-and-forth, known as a pill-rolling tremor. Your hand may tremor when it's at rest. Slowed movement (bradykinesia). [mayoclinic.org]

The tremor types are summarized in Table 1 and graphically explained in Figure 1. Type I is pure resting tremor, including the classical pill-rolling tremor. [hindawi.com]

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X-linked Parkinsonism-Spasticity Syndrome

T2-weighted fast spin echo (G) and T1-weighted (H) brain MRI scans from a child with PKAN demonstrating the "eye of the tiger" sign (courtesy of Susan J. [ojrd.biomedcentral.com]

[…] extrapyramidal motor function Focal-onset seizure Cerebellar atrophy Dilated third ventricle Scissor gait Dilation of lateral ventricles Hyperactive deep tendon reflexes Ankle clonus Mask-like [mendelian.co]

[…] of the head (and sometimes trunk) due to cerebellar disease Parkinsonian Tremor Most common cause of a resting tremor that usually involves the distal muscles (e.g. pill [stanfordmedicine25.stanford.edu]

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Postencephalitic Parkinson Disease

PARKINSON’S DISEASE Parkinson’s disease is characterized by a characteristic pill rolling tremor, bradykinesia, mask-like facies with a reduced blinking frequency (hypomimia [thebigl.co]

Most characteristic, and often present early in the course of the disease, is an asymmetric, coarse (3-7 cps) "resting" tremor characterized as pill-rolling. [enotes.tripod.com]

It is important to distinguish the pill rolling tremor from essential tremor. [thebigl.co]

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Parkinsonism

[…] tremor; 4–6 Hz), paucity and slowness of movement (hypokinesia, bradykinesia) and generalized rigidity (cogwheel and lead-pipe rigidity), festinant gait, stooped posture, mask-like [medical-dictionary.thefreedictionary.com]

Signs include "mask-like" facies and "cog-wheel rigidity." See Also: Neuroleptic Induced Parkinsonism paralysis agitans Parkinson's Disease [behavenet.com]

It is so named because the condition gives the affected person a fixed, mask-like expression. [verywellhealth.com]

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Pallidopyramidal Syndrome

Sometimes the report from a radiologist can state NBIA with classic features like “eye of a tiger sign” that can ease the diagnostic burden. [annalsofian.org]

[…] nervous system]; Parkinsonism; Hypokinesia; Akinesia; Mask-like facies; Rigidity; Anarthria; Festinate gait; Facial-faucial-finger mini-myoclonus (FFF); Spasticity; Mild [genome.jp]

Pill-rolling tremor, hypomimia, hypophonia, stooping posture, striatal toes and equinovarous deformity may be noted. [neurologyindia.com]

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Progressive Supranuclear Palsy

Often PSP does not respond to levodopa therapy, whereas the rigidity accompanying PD should improve with therapy.[4] The hallmark “pill rolling” tremor of PD is usually absent [eyewiki.aao.org]

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Kufor-Rakeb Syndrome

Brain MRI usually shows bilateral “eye-of-the-tiger” sign. CT scan shows bilateral calcifications and corresponding to the central spot visible on MRI21. [scielo.br]

Symptoms List: Kufor-Rakeb Syndrome Symptoms and clinical features may include: 3 Clinical Features of Kufor-Rakeb Syndrome : Autosomal recessive inheritance Mask-like facies [familydiagnosis.com]

People with PD may experience: Tremor, mainly at rest and described as pill rolling tremor in hands. [parkinson.org]

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Dementia with Lewy Bodies

The classical, slow, pill-rolling resting tremor of PD is rare in MSA. What is mostly found is an irregular, higher-frequency postural tremor. [doi.org]

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Atypical Juvenile Parkinsonism

Coronal and axial T2-weighted MRI of patient A showing the "eye of the tiger sign". [demneuropsy.com.br]

The “masked facies” of Parkinson's disease is an example of slowed nonvolitional movement. [aafp.org]

Phenothiazines Butyrophenones Selective serotonin reuptake inhibitors Specific drugs Amiodarone Diltiazem Metoclopramide Valproic acid The asymmetrical and unilateral onset of a pill-rolling [clevelandclinicmeded.com]

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Parkinson Disease Late-Onset

Mask-like facies MedGen UID: 140860 •Concept ID: C0424448 • Finding A lack of facial expression often with staring eyes and a slightly open mouth. [ncbi.nlm.nih.gov]

Some people develop a pill-rolling tremor, a repetitive motion of rubbing the thumb and forefinger together as if rolling a small object between them. [verywellhealth.com]

You may a rub your thumb and forefinger back-and-forth, known as a pill-rolling tremor. Your hand may tremor when it's at rest. Slowed movement (bradykinesia). [mayoclinic.org]

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Extrapyramidal Disorder

Some patients with tardive Parkinsonism lack facial expressions (mask-like facies) and they may drool. [medicalnewstoday.com]

It includes muscle stiffness, pill rolling tremor and reduced movements (Bradykinesia). It usually occurs months after start of antipsychotic drug treatment. [mentalhealthdoc.blogspot.com]

[…] typically appears unilaterally, pill rolling tremor 63. [slideshare.net]

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Systemic Scleroderma

[…] appearance of the skin and limited range of motion Atrophy and necrotic spots Lesions on the proximal nail fold Multiple, painful ischemic digital ulcers Face Loss of expression (mask-like [amboss.com]

facies) Shortened frenulum Microstomia accompanied with characteristic perioral wrinkles Vascular disease Raynaud's phenomenon Thromboembolism Fatigue, weakness Joint stiffness [amboss.com]

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Hereditary Late-Onset Parkinson Disease

Mask-like facies MedGen UID: 140860 •Concept ID: C0424448 • Finding A lack of facial expression often with staring eyes and a slightly open mouth. [ncbi.nlm.nih.gov]

You may a rub your thumb and forefinger back-and-forth, known as a pill-rolling tremor. Your hand may tremor when it's at rest. Slowed movement (bradykinesia). [mayoclinic.org]

[…] in the hands and may involve repetitive movements of the thumb and forefinger, known as “pill rolling” tremors. [soc.ucsb.edu]

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Diffuse Scleroderma

Chest. 1983 Nov;84(5):546-50. Abstract The pulmonary function and chest roentgenograms were evaluated in 88 patients with the CREST syndrome variant of progressive systemic sclerosis (PSS or scleroderma). Seventy-two percent of the patients had abnormal pulmonary function. An isolated decrease in diffusing[…] [ncbi.nlm.nih.gov]

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Moebius Syndrome

A 4-year-old boy presented with mask-like facies noted at birth after a 34-week pregnancy. [ncbi.nlm.nih.gov]

A case of Möbius' syndrome is presented, with the mask-like facies and poor social relationships consistent with this diagnosis. [ncbi.nlm.nih.gov]

The main nerves affected are the sixth (CN VI) and the seventh (CN VII) which results in abnormal gazing and mask like facies. [eyewiki.aao.org]

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Limited Cutaneous Systemic Scleroderma

facies) Shortened frenulum Microstomia accompanied with characteristic perioral wrinkles Vascular disease Raynaud's phenomenon Thromboembolism Fatigue, weakness Joint stiffness [amboss.com]

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Freeman-Sheldon Syndrome

A six-day-old girl, born to normal non-consanguineous parents presented with mask like facies with a small mouth giving a 'whistling' appearance. [ncbi.nlm.nih.gov]

1975; Joseph Harold Sheldon, British physician, 1920-1964 An autosomal dominant [MIM 193700] or less commonly, or autosomal recessive [MIM 277720] condition with atypical mask-like [medical-dictionary.thefreedictionary.com]

She has dysmorphic mask like facies which has whistling appearance and other features include deep set eyes, broad nasal bridge, short neck, hypoplasia of the ala nasai, long [elynsgroup.com]

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Malignant Hyperthermia - Arthrogryposis - Torticollis

facies Expressionless face Lack of facial expression Mask-like facial appearance [ more ] 0000298 Metatarsus adductus Front half of foot turns inward 0001840 Plagiocephaly [rarediseases.info.nih.gov]

30%) HP:0006610 18 webbed neck 59 32 hallmark (90%) Very frequent (99-80%) HP:0000465 19 hyperconvex fingernails 59 32 occasional (7.5%) Occasional (29-5%) HP:0001812 20 mask-like [malacards.org]

[…] weakness Rigidity Apnea Tics Muscular dystrophy Minicore myopathy Hypertrophic cardiomyopathy Short neck Hepatomegaly Abnormality of the skeletal system Flat face Kyphosis Mask-like [mendelian.co]

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Methylphenyltetrahydropyridine

[…] monoxide poisoning Presentation Symptoms motor involvement resting pill-rolling tremor bradykinesia muscle rigidity cogwheel rigidity postural instability shuffling gait mask-like [medbullets.com]

One patient exhibited a "pill-rolling" tremor (5 to 6 cycles per second) at rest in the right hand. [scienceintheclassroom.org]

There is a “pill-rolling” resting tremor accentuated when the patient is asked to perform mental calculations. [medbullets.com]

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Secondary Myopathy

This article is available to subscribers. Subscribe now. Already have an account? Sign in Medical Intelligence Free Preview Archive E. Prather Palmer, M.D., and André T. Guay, M.D. This article has no abstract; the first 100 words appear below. BINGE—PURGE eating behavior is characteristic of two major eating disorders:[…] [nejm.org]

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Hallervorden-Spatz Syndrome

Iron deposition in conjunction with destruction of the globus pallidus gives rise to the characteristic eye-of-the-tiger sign in MRI. [ncbi.nlm.nih.gov]

[…] of the tiger" sign. [ncbi.nlm.nih.gov]

It has been postulated that pantothenate kinase 2 mutations underlying all cases of classic Hallervorden-Spatz syndrome are always associated with the eye-of-the-tiger sign [ncbi.nlm.nih.gov]

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Facioscapulohumeral Muscular Dystrophy

Facioscapulohumeral muscular dystrophy (FSHD) is a genetic muscle disorder in which muscles of the face, shoulder blades, and upper arms develop gradual and progressive weakness. There is no effective pharmacological treatment currently available for this disorder so far. We had an opportunity to treat a patient[…] [ncbi.nlm.nih.gov]

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Early-Onset Parkinson Disease 20

You may a rub your thumb and forefinger back-and-forth, known as a pill-rolling tremor. Your hand may tremor when it's at rest. Slowed movement (bradykinesia). [mayoclinic.org]

The tremor most often starts in one hand (often described as a ‘pill-rolling tremor’), and may progress to affect the other hand and the arms and legs. [mydr.com.au]

[…] in the hands and may involve repetitive movements of the thumb and forefinger, known as “pill rolling” tremors. [soc.ucsb.edu]

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Myasthenia Gravis

We describe the case of a 3-week-old boy with pyloric stenosis who presented for laparoscopic pyloromyotomy in the setting of symptomatic transient neonatal myasthenia gravis. The patient received muscle relaxation with rocuronium, and neuromuscular blockade was successfully reversed with sugammadex with[…] [ncbi.nlm.nih.gov]

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Ataxia Telangiectasia

A 9-year-old girl born to healthy parents showed manifestations suggestive of ataxia telangiectasia (AT), such as short stature, sudden short bouts of horizontal and rotary nystagmus, a weak and dysarthric voice, rolling gait, unstable posture, and atactic movements. She did not show several cardinal features[…] [ncbi.nlm.nih.gov]

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Idiopathic Basal Ganglia Calcification

Neurological presentations include movement disorders (tremors, poor coordination, loss of fine-motor control, chorea, choreoathetosis) or rigid dystonia (mask-like facies [canglish1.tripod.com]

Fahr's Syndrome can also include symptoms characteristic of Parkinson's disease such as tremors, muscle rigidity, a mask-like facial appearance, shuffling gait, and a "pill-rolling [ninds.nih.gov]

muscle rigidity, a mask-like facial appearance, shuffling gait, and a "pill-rolling" motion of the fingers. [viartis.net]

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Marburg Virus Disease

Marburg virus belongs to the genus Marburgvirus in the family Filoviridae and causes a severe hemorrhagic fever, known as Marburg hemorrhagic fever (MHF), in both humans and nonhuman primates. Similar to the more widely known Ebola hemorrhagic fever, MHF is characterized by systemic viral replication,[…] [ncbi.nlm.nih.gov]

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Encephalitis Lethargica

An expressionless, mask-like facies was frequently described. The descriptive epithet “sleepy sickness” was often attributed to this form of the disease. [doi.org]

PEP could be distinguished from Parkinson's disease (PD) based on an early age of onset and because the associated tremor was not the typical pill-rolling tremor seen in PD [symptoma.com]

In the acute stage, EL presented as encephalitis with either somnolent or manic behavior, mask-like facies, muscular rigidity, involuntary eye movements, and a tremor which [doi.org]

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