Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein

Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. he was started on levodopa-carbidopa and a neuropathy workup was requested. His follow-up visit after three Proglumide months was remarkable for significant improvement of his tremors with carbidopa-levodopa. However, his blood work was consistent with a significant Proglumide increase in lambda light chain levels and the presence of an M spike in serum protein electrophoresis. Based on the presentation and clinical workup, he was finally found to have both multiple myeloma and ?Waldenstroms macroglobulinemia. Underlying malignancy was treated with chemotherapy and immunotherapy. Levodopa-carbidopa was discontinued after three months of chemotherapy and his tremor did not recur in one year of follow-up. Gammopathy is one of Rabbit Polyclonal to A4GNT the well-known causes of tremors in the adult population. It can cause both resting and kinetic tremors in the upper extremities. It is supposed that peripheral neuropathy associated with gammopathy is the main underlying cause of tremors in these groups of patients. However, central causes are also suggested. In this case, we are led to conclude that our patients tremor was centrally mediated since it responded well to dopamine replacement therapy. However, further study is needed to elucidate the role of dopamine depletion in the pathogenesis of tremors associated with gammopathies. strong class=”kwd-title” Keywords: lambda paraproteinemia, dopamine repletion, gammopathy, parkinsonism, tremor Introduction Monoclonal gammopathy can present with systemic symptoms such as fatigue, generalized weakness, weight loss?as well as anemia, bleeding, and increased bruising. This condition may lead to the involvement of the nervous system, be it the central or peripheral nervous system, causing changes in mental status, headache, visual changes, peripheral neuropathies, etc.?Monoclonal gammopathy-associated tremors have been well-described?[1]. Gammopathy is one of the well-known causes of tremors in the adult population. It can cause both resting and kinetic tremors in the upper extremities. It is supposed that peripheral neuropathy associated with gammopathy is the main underlying cause of tremors in these groups of patients. However, central causes are also suggested. Case presentation The patient is a 75-year-old?Caucasian, right-handed male?who presented with bilateral hand shakiness. His tremors had started one year ago but had gotten worse during the last two months. The tremor was noted to be more severe in his right hand. He was a professional chess player, but he had recently developed difficulty playing chess and difficulty with handwriting due to tremors. He had a remote history of right hip trauma for which he underwent surgery, but it was complicated with shortening of the right femur and limping, and his gait had become more unsteady during the last two months, which resulted in using a cane. His hand tremors were both at rest and with movements. Review of systems was remarkable for limping and also numbness and tingling in his feet. It was negative for double vision, blurred vision, drooling, ?dysphonia or dysphagia, memory impairment, hallucination, mood change, disinhibition, agitation, depression, anxiety, hands or limbs weakness, constipation, changes in smell, urinary incontinence, abnormal ?movements or kicking during sleep, recent falls and hearing problems, family or personal history of essential tremor or Parkinsons disease, and drinking excessive coffee or alcohol. His past medical history was remarkable for chronic kidney disease (CKD) stage III and well-controlled type 2 diabetes mellitus for 10-15 years on oral hypoglycemic agents complicated by diabetic neuropathy. His neuropathic symptoms Proglumide such as numbness and tingling in his feet have started Proglumide five years ago and used to be very mild?-1/10 in severity, and he had never been on any medication for his mild neuropathic pain. However, he had noticed some worsening of his numbness and tingling for the last two months?and also worsening in his limping, and he started using a cane at the same time. He was never a smoker and drinker. He was able to drive and was independent with simple and complex activities of daily life. Positive findings in his neurological examination Proglumide were pill-rolling resting tremor (more pronounced in the right hand), with a frequency of 6-8 Hz, which was enhanced with mental distraction and ?contralateral voluntary movements, mild to moderate postural and action tremor of bilateral arms,.

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