Hepatology An involuntary jerking tremor of wide amplitude elicited upon dorsiflexion of the pronated wrist and spreading of extended fingers; in full-blown flapping tremors, there is abrupt flexion of the fingers at the metacarpophalangeal joint and flexion of the wrist, occurring asynchronously with each other every few seconds, due to exaggerated reflexes; bilateral flapping tremor is quasi-pathognomonic for metabolic, often alcohol-related, hepatic encephalopathy seen in end-stage—post-fibrotic—cirrhosis due to increased blood ammonia
Neonatology Coarse bilateral tremors, accompanied by limb rigidity, hyperreflexia, resistance to flexion and extension, seen in infants born to heroin-addicted mothers who undergo ‘withdrawal’ at birth