Reversible hand tremors, downbeat nystagmus, and an unsteady gait with nontoxic lithium level.

Patients with nontoxic lithium levels can still develop hand tremors, downbeat nystagmus, and an 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.

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