Key Clinical Message
Patients with nontoxic lithium levels can still develop hand tremors, downbeat nystagmus, and an unsteady gait.
Keywords: downbeat nystagmus, lithium, tremor, unsteady gait
Four years of hand tremors, 2 years of jumpy eyes, and 6 months of unsteady gait with frequent falls caused the 60‐year‐old woman to be on forced medical leave. In the past 3 years, primidone, propranolol, sinemet, and amantadine have been tried without significant improvement. The patient has been taking lithium for more than 20 years. The lithium level was normal: 0.9 mmol/L (normal range: 0.6‐1.2 mmol/L). The MRI of brain was not remarkable (Figure 1). On examination, the patient had downbeat nystagmus, tremors, and an unsteady gait. Lithium medication was stopped, and symptoms improved within one month1, 2 (Video S1).
Figure 1.
The MRI of the brain is unremarkable
CONFLICTS OF INTEREST
The author declares no conflicts of interest.
AUTHOR CONTRIBUTION
YYP: was the neurologist for this patient.
Supporting information
Peng Y‐Y. Reversible hand tremors, downbeat nystagmus, and an unsteady gait with nontoxic lithium level. Clin Case Rep. 2019;7:599–600. 10.1002/ccr3.1981
REFERENCES
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