Clinical Phenomenology. Patient 1. Examination with arms extended in the “karate chop” position demonstrates episodic postural hand tremor and bilateral “spooning”. Patient 2. Examination with arms extended in the “karate chop” position demonstrates. (A) Episodic, irregular postural hand tremor and “spooning” on left, with superimposed jerky movements and (B) episodic head tremor with head turn to left and hypertrophy of the right sternocleidomastoid muscle, consistent with concomitant cervical dystonia. Patient 3. Examination with arms extended and pronated demonstrates bilateral, episodic postural hand tremor and unilateral “spooning” on left.