Perceived Weakness, Clumsiness, Minor Speech Difficulties

[tom3]

I am a 54yo white man, mild high BP (140/90) and cholesterol (220) but otherwise no medical problems.  Two weeks ago I noticed my right arm was feeling "floppy" -- loose and weak.  Had it checked out by my PCP a couple of days later, nothing clinically significant found. This has progressed to both arms and sometimes legs though the right side is always more than the left, and the arms more than the legs.

My limbs are not actually weak, e.g. I can still pick up my 80# daughter w/ no extra effort, and did gardening all weekend  no trouble.  Grip strength is normal, but I feel uncoordinated and stiff in the fingers and a little clumsy, I've had pens fly out of my hand twice for no reason, and tripped when there wasn't anything unusual to trip over.  I have occasional fasciculations (right arm, left calf and shoulder) and tremors in my right hand and occ the left.  Tremors are not new but seem a bit worse; there is a family history of essential tremor.  I have also noticed some minor speech difficulties, particularly with "sh" sounds followed by things like "ts" or "st" -- for example in conversation I pronounced "crushed stone" as "crush shtone" and had to try 3 times to get it right.

All this started w/in a week after BP meds were increased from 10 mg to 40 mg lisinopril/day, but I know neuro effects are rare w/
lisinopril.

I am an anxious type re health and my big worry of course is ALS.  I also wonder about brain tumor, stroke, etc.  I know you can't diagnose online but just would like to know what impression all this gives and what the possibilities are.  Thanks!

[CCF-Neuro-M.D.-PW]

Your symptoms have developed over just 2 weeks and seem to be temporally realtred to the medication change

This would make it more likely that the symptoms are a result of the medication change and not ALS. ALS usually progresses slowly and onvolves one limb or area first then others (ie not fasciculations in multiple area within 2 weeks)
Also, fasciculations in the absence of muscle weakness and wasting are not likely to be due to ALS.
Fasciculations can also be caused by excercise, cold, pinched nerves, and certain medications, very rarely by some viral infections involving the spinal cord.

If your blood pressure was lowered too much, quickly, by the medication (even if it is still within 'normal range', this could explain your symptoms
Also, this type of medication, in individuals with narrowing of the renal arteries, can cause kidney problems - this should be checked wwith some blood work.

Other potential neurological reasons, could include a viral or postviral involving the peripheral nerves, othermedications (but you have no history of this), or the beginning ofa more chronic disorder (although this is very unlikely, and will be borne out by time, nothing specific comes to mind)

Start with talking to your doctor about the medication change, rechecking your blood pressures, and getting the bloodwork done

[tom3]

Follow-up:  Had a neuro appt today. He said nothing in my story or the exam was worrisome, and that given an unremarkable head / neck MRI and MRA a little over a year ago (done due to mild dizziness, the only finding was small vessel disease due to hypertension), then the chances of finding anything new with another MRI would likely be in the 1% or less range, and it was my choice whether to proceed or not.

This makes sense to me but I would still be interested in any additional comments re either the symptoms or the possible link to medication (lisinopril).

How often do collections of neuro symptoms show up with unexplained causes and turn out not to be due to anything serious?

Thanks ...