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To evaluate the cause, frequency and determinants of tremors at secondary care settings.A hospital based cross-sectional study for seven years (2002-2009) was carried out at Sindh Govt. Hospital (SGH) Liaqatabad No.10, Karachi. Sample size was 403 and sampling technique was Convenience sampling. A data collection form was designed and all essential variables were recorded regarding age, gender, residence, complaints and their duration, education status, profession, co-morbid and investigations performed. The results were analyzed using SPSS 16.0.Out of 403 patients 247 (61.5%) were males and 156 (38.5 %) were females. The mean age of the patients was 55.9 +/- 14.2 years. The male to female ratio was 2: 1.6. Enhanced physiological tremor was the most frequent diagnosis. Among whom, females of 40-60 years were mostly affected. Essential tremors were mainly coarse in amplitude, whereas commonest fine tremors were diagnosed as Enhanced Physiological tremor.Evaluation of patients with tremors showed males to be more affected with essential tremors being the commonest encountered. Orthostatic tremor was rare. Essential tremors were diagnosed by exclusion.

Goldston syndrome is a rare entity describing the association of polycystic kidneys and Dandy Walker malformation with or without hepatic fibrosis. A 28 years old pregnant woman came to radiology department for the first antenatal scan. Ultrasound showed a single fetus corresponding to 27 week of gestation. The fetal brain revealed deficient vermis with a posterior fossa cyst communicating with the 4th ventricle suggestive of Dandy-Walker malformation (DWM). The kidneys were enlarged, and echogenic containing small cysts with associated amniotic fluid index of 5 cm suggestive of oligohydramnios. A diagnosis of Goldston syndrome was suggested. These findings were confirmed on post natal head and renal ultrasound.