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Left arm jerking
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Left arm jerking


Posted by Robert Twichell on June 18, 1999 at 09:10:52
Had a small stroke in early March, left arm, hand, leg numbness for a few minutes. MRI showed a small amount of damage in brain. Am on Plavix(75 mg), Lipitor (20 mg), Hydrochlorothiazide (25mg).
No symptoms now other than muscle weakness, and a left arm jerk in response ro any sudden noise. The jerk is maybe 2 inches. Yesterday one happened in steering the auto causing the car to swerve into the oncoming traffice lane. The cause was a cough of one of the passengers! Fortunately there were no cars  in the oncoming lane.
What is causing the sudden left arm jerk? Should anything be done? What?
Posted by CCF Neuro[P] MD, RPS on June 18, 1999 at 16:29:44
Dear Robert:
Sorry to hear about your stroke.  It sounds like you may have stimulus induced myoclonus.  It is difficult to say, without looking at the MRI whether this will improve.  One of the things that you will have to do, as you already have done is to know in what situations the left arm jerk will occur and try to prevent accidents from happening.  I guess you'll become a right handed coffee drinker.  I would see your neurologist for a couple of reasons.  First, the jerk may be correlated to abnormal brain activity, seizure-like event.  They may be due to the brain healing and therefore temporary.  They may be due to the hypoxic event during the stroke and not related to abnormal brain activity.  There are medications that can be used, in some cases, and he/she would be the one to follow the levels and the dosing. So depending on the etiology, medication might be a problem solver.  Let us know what happens.
Sincerely,
CCF Neuro MD

Posted by Robert Twichell on June 23, 1999 at 17:05:22
What are the odds of it just going away with time? Is that a risky approach? Why?
And is it likely to be related to any of my  meds? Again, am on Plavix(75 mg), Lipitor (20 mg), Hydrochlorothiazide (25mg).
Posted by CCF Neuro[P] MD, RPS on June 24, 1999 at 16:45:39
Dear Robert:
Whether it will go away is difficult for me to answer.  When myoclonic activity is associated with a hypoxic insult (i.e. stroke) it may be transitatory.  It is still relatively early in the coarse of things.  However, if the myoclonic jerks are associated with EEG changes then it might reduce the chances of spontaneous recovery.  Give it 6 months or so.  If it doesn't seem like it is getting better after 6 months then I would get it looked at by the epileptologist.  The medications that you are taking are not associated with myoclonus as far as I know.
I hope this helps alittle.
Sincerely,
CCF Neuro MD

Posted by Robert Twichell on June 26, 1999 at 09:45:20
any evidence that Ginkgo, 75 mg, could lead to stimulus induced myoclonus?  My NP said that Ginkgo might improve my memory.
tnx,
Bob

Posted by CCF Neuro[P] MD, RPS on June 26, 1999 at 16:23:42
Dear Robert:
No, Ginkgo should have no effect on your myoclonus.  The active ingredient in Ginkgo preps is a vasodilator-like agent.  Different companies have different amounts within a dose so you had better make sure what your taking is what is described.  Herbals are not monitored by the FDA so they do not have to have a standard purity or amount.  However, your NP should have warned you against taking it along with Plavix.  Your increasing your chance for a hemorrhagic stroke.  Since you have already had a stroke, I would caution you about this.
Sincerely,
CCF Neuro MD

Posted by Robert Twichell on June 29, 1999 at 10:39:35
If ginkgo is a vasodilator and my stroke was said to be caused by an errant clot, of piece of plaque it would seem that ginkgo would reduce probability of future strokes? And maybe improve my rehabilitation?

Posted by CCF Neuro[P] MD, RPS on June 29, 1999 at 10:49:27
Dear Robert:
No, you are also taking Plavix which is a anti-platelet, thiazide which is a vasodilator, which taken together with an uncontrolled medication (dose of active agent) can be lethal by causing hemorrhagic stroke.  But now that you know this, it is up to you.
Sincerely,
CCF Neuro MD

Posted by Robert Twichell on June 30, 1999 at 17:32:49
No more ginkgo here!!!
Bob

Posted by CCF Neuro[P] MD, RPS on June 30, 1999 at 18:12:54
Dear Robert:
I think you made the correct choice.
Sincerely,
CCF Neuro MD

Posted by Robert Twichell on July 03, 1999 at 16:57:15
have a session with Nurse Practitioner, and a neurologist( I guess he is!) Tuesday morning re: SIM
thanks for your help
Bob

Posted by CCF Neuro[P] MD, RPS on July 03, 1999 at 21:06:54
Your welcome.
CCF Neuro

Posted by Robert Twichell on July 11, 1999 at 14:46:20
doctor went into quite a discussion of the pros and cons of Haldol and I decided not to take it and just watch for an easing off of jerking symptoms which has already taking place. The jerks are less apparent, maybe 50% decreased.
One thing I forgot to mention to the neurologist, and the NP, and which my GP says is nothing to be concerned about is a pressure under my left scapula, not a pain, but more like the sensation of a swelling. It is about 6 inches above my belt line.
  

Posted by CCF Neuro[P] MD, RPS on July 11, 1999 at 19:53:06
Dear Robert:
It is difficult to tell you what the sensation is from.  Without the benefit of examing you it is almost impossible.  I would give it the tincture of time to see if it improves or gets worse.
Haldol is not the answer for myoclonus.
Sincerely,
CCF Neuro[P] MD

Posted by Robert Twichell on July 12, 1999 at 10:05:27
if Haldol is not, what is? Or have I remembered the wrong drug?
Bob

Posted by CCF Neuro[P] MD, RPS on July 12, 1999 at 11:27:05
Dear Robert:
Haldol is an anti-psychotic medication.  We also use it for tic disorders.  It is not used for myoclonus.
CCF Neuro MD

Posted by Robert Twichell on July 12, 1999 at 14:05:41
what does CCF use for Myoclonus?
Bob

Posted by Robert Twichell on July 12, 1999 at 14:10:43
going back to my session with the NP and neurologist at SMH. I see that he said I had not Myoclonus but Hemiballism, but inferred they are about the same thing.
Bob

Posted by CCF Neuro[P] MD, RPS on July 13, 1999 at 18:09:00
Dear Robert:
No, they are alike but the etiology of each is different.  Hemiballismus is from a lesion in the subthalmus on the side of the affected limb.  Myoclonus can be from a number of etiologies but not associated with the subthalmus.  Depending on the extent of the lesion, hemiballismus can be either mild or severe.  Sounds like you have the mild type.
Sincerely,
CCF Neuro MD



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