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Unexpected outcome (positive or negative) including adverse drug reactions
CASE REPORT
The effect of a therapeutic lithium level on a stroke-related cerebellar tremor
  1. Rachel A Orleans1,
  2. Marc J Dubin2,3,
  3. Kristopher A Kast2
  1. 1Weill Cornell Medical College, Weill Cornell Medicine, New York, NY, USA
  2. 2Payne Whitney Psychiatric Clinic, New York-Presbyterian/Weill Cornell Medical Center, New York, NY, USA
  3. 3Feil Family Mind and Brain Institute, Weill Cornell Medical College, New York, NY, USA
  1. Correspondence to Rachel A Orleans, rao2003{at}med.cornell.edu

Summary

Lithium is a mood stabiliser used in the treatment of acute mania, bipolar disorder and as augmentation for unipolar major depression. Tremor is a common adverse effect associated with lithium at both therapeutic and toxic serum levels. We present a case of dose-dependent changes in the quality and intensity of a stroke-related, chronic cerebellar tremor with lithium treatment at serum levels within the therapeutic range. On admission, the patient in this case had a baseline fine, postural tremor, which increased in frequency and evolved to include myoclonic jerks once lithium therapy was initiated. Although the patient’s serum lithium level was never in the toxic range, his tremor returned to baseline on reduction of his serum lithium level. This case highlights that a pre-existing, baseline tremor may lower the threshold for developing myoclonus. It also suggests that caution may be warranted with lithium therapy in the setting of known cerebellar disease.

  • psychiatry (drugs and medicines)
  • unwanted effects / adverse reactions
  • drugs: psychiatry
  • mood disorders (including depression)

https://doi.org/10.1136/bcr-2017-222920

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    Footnotes

    • Contributors RAO: conception of the work; acquisition, analysis and interpretation of data; drafting the work; revising it critically for important intellectual content; final approval of the version published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. MJD and KAK: acquisition, analysis and interpretation of data; revising the work critically for important intellectual content; final approval of the version published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.