Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Book Review
Brief Report
Case Letter
Case Report
Case Series
Commentary
Current Issue
Editorial
Erratum
Guest Editorial
Images
Images in Neurology
Images in Neuroscience
Images in Neurosciences
Letter to Editor
Letter to the Editor
Letters to Editor
Letters to the Editor
Media and News
None
Notice of Retraction
Obituary
Original Article
Point of View
Position Paper
Review Article
Short Communication
Systematic Review
Systematic Review Article
Technical Note
Techniques in Neurosurgery
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Book Review
Brief Report
Case Letter
Case Report
Case Series
Commentary
Current Issue
Editorial
Erratum
Guest Editorial
Images
Images in Neurology
Images in Neuroscience
Images in Neurosciences
Letter to Editor
Letter to the Editor
Letters to Editor
Letters to the Editor
Media and News
None
Notice of Retraction
Obituary
Original Article
Point of View
Position Paper
Review Article
Short Communication
Systematic Review
Systematic Review Article
Technical Note
Techniques in Neurosurgery
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Book Review
Brief Report
Case Letter
Case Report
Case Series
Commentary
Current Issue
Editorial
Erratum
Guest Editorial
Images
Images in Neurology
Images in Neuroscience
Images in Neurosciences
Letter to Editor
Letter to the Editor
Letters to Editor
Letters to the Editor
Media and News
None
Notice of Retraction
Obituary
Original Article
Point of View
Position Paper
Review Article
Short Communication
Systematic Review
Systematic Review Article
Technical Note
Techniques in Neurosurgery
View/Download PDF

Translate this page into:

Letter to the Editor
11 (
1
); 212-213
doi:
10.1055/s-0039-3399480

Lip Tremor in Hypocalcemia

Department of Neurology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
Department of Neurology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
Department of Endocrinology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
Address for correspondence Niraj Kumar, MD, DM Department of Neurology, All India Institute of Medical Sciences, Rishikesh 249203 Uttarakhand India drnirajkumarsingh@gmail.com
Licence
This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Disclaimer:
This article was originally published by Thieme Medical and Scientific Publishers Private Ltd. and was migrated to Scientific Scholar after the change of Publisher.

Neuromuscular hyperexcitability (NH) resulting from hypocalcemia commonly manifests as facial twitching and perioral tingling.1 Lip tremor in hypocalcemia has never been reported to the best of our knowledge. We report a postpartum female, with two previous miscarriages, presenting with seizures and lip tremor and diagnosed with hypocalcemia.

A 23-year-old woman, 5 days postpartum with past history of two second-trimester miscarriages presented with new-onset generalized tonic–clonic seizures and lip tremor without fever, headache, or vomiting. Trousseau’s and Chvostek’s signs were positive, and neurological examination revealed a rhythmic, 8 to 10 Hz tremor involving upper lip (Video 1). Computed tomography of the brain revealed bilateral basal ganglia, thalamus, subcortical white matter, red, and dentate nuclei calcification (Fig. 1). Electroencephalogram was nonconclusive. Blood work-up revealed reduced calcium of 1.37 mmol/L (normal, 2.14–2.56), raised phosphate of 8.22 mg/dL (normal, 3–4.5), reduced parathyroid hormone of 4 pg/mL (normal, 12–88), and vitamin D of 9.55 ng/mL (normal, 10–55), thereby suggesting a diagnosis of idiopathic hypoparathyroidism. Gynecological and hematological investigations including anticardiolipin antibodies returned nonconclusive. We treated her initially with intravenous calcium gluconate followed by oral elemental calcium 2 g/d and calcitriol 1.5 g/d. Her symptoms including lip tremor subsided over subsequent 4 weeks (Video 1).

Fig. 1 Noncontrast computed tomography of the brain showing calcifications in bilateral basal ganglia, thalamus, and subcortical white matter (A) and cerebellum (B).

Fig. 1 Noncontrast computed tomography of the brain showing calcifications in bilateral basal ganglia, thalamus, and subcortical white matter (A) and cerebellum (B).

Hypocalcemia is common in pregnancy, mostly due to hypoparathyroidism and dietary deficiency.2 Long-standing idiopathic hypoparathyroidism was the cause in our case. NH resulting from reduced extracellular calcium modulates various receptors and ion channels,3 commonly manifesting as muscle spasms, cramps, twitchings, paresthesia, numbness, and seizure.1 Lip tremor in our case appears related to NH. NH may increase uterine irritability leading to miscarriages,4 as reported by our case. Nearly 30 g of calcium is transferred from mother to the fetus throughout pregnancy with maximum in the last trimester.2 4 Thus, long-standing hypocalcemia in pregnancy is more likely to manifest in the peripartum period as evidenced in our case. Asymptomatic hypocalcemia in pregnancy is widely prevalent in India,5 and regular monitoring of serum calcium and a calcium-rich diet in pregnancy is essential.

Authors’ Contributions

N.K.: Conception, design, writing the first article, review, and critique. V.P.: Review and critique.

Conflict of Interest

None declared.

Funding None.

References

  1. , , . Review of hypoparathyroidism. Front Endocrinol (Lausanne). 2017;7:172. (JAN)
    [Google Scholar]
  2. , , , . Hypocalcemia in pregnancy: a clinical review update. Oman Med J. 2018;33(6):453-462.
    [Google Scholar]
  3. , , , . Hypocalcemia-induced seizure: demystifying the calcium paradox. ASN Neuro. 2015;7(2):1-9.
    [Google Scholar]
  4. , , , et al. . Management of hypoparathyroidism in pregnancy and lactation - a report of 10 cases. Bone Rep. 2015;3:15-19.
    [Google Scholar]
  5. , , , , , . Hypocalcemia in pregnant women. Biol Trace Elem Res. 2010;136(1):26-32.
    [Google Scholar]

Fulltext Views
762

PDF downloads
139
View/Download PDF
Download Citations
BibTeX
RIS
Show Sections