The effect of a therapeutic lithium level on a stroke-related cerebellar tremor

Abstract

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.

Lithium Biological Action Mechanisms after Ischemic Stroke

“…It can also be characterized as an irregular, non-rhythmic tremor of the lower extremities. In some cases, abnormal movement abnormalities such as dysarthria, aphasia, and choreoathetosis can also be caused by severe lithium intoxication [82].…”

Differentiating Between Lithium Tremors and Extrapyramidal Tremors in a Patient on Long-Term Antipsychotics and Lithium Medication

“…Lithium-induced tremors are a type of postural tremor that fall under the category of exaggerated physiological tremors [ 3 ]. They are observed when a specific posture is voluntarily maintained against gravity and typically exhibit a frequency of 8-12 Hz [ 4 ]. Lithium-induced tremors typically manifest early during treatment, although they can appear at any point in time.…”