Recurrent orthostatic numbness with carotid stenosis and beta-blocker use

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Results:The episodes began when the patient was placed on twice a day 50 mg dose of Lopresor. The patient presented with stereotypic, recurrent, transient numbness involving his entire right arm. Every such episode occurred on changing from a supine or sitting posture into an upright one, lasted less than a minute in duration, and resolved rapidly when the patient became supine again. They increased in frequency when the dose was increased first to 75 mg twice a day and then to 100 mg twice a day, with the patient having daily episodes on admission. Lopresor was discontinued and the patient's symptoms resolved.AdverseEffects:1 patient had recurrent orthostatic numbness.AuthorsConclusions:Anti-hypertensive medications can uncover otherwise asymptomatic carotid disease and alter the course of patient management by precipitating surgical intervention. Conversely, one could argue that these medications should be used cautiously in patients with known high-grade stenosis even in the absence of significant orthostatic hypotension. The TIA [transient ischemic attack] reported here is a classical example of a perfusion failure TIA. These TIAs are frequently associated with severe carotid stenosis and signify distal insufficiency.FreeText:The patient's admission orthostatic measurements were: supine blood pressure (BP) 117/69, pulse 63; standing BP 108/61, pulse 59. Subsequent orthostatic measurements were: supine BP 142/82, pulse 69; standing BP 139/84, pulse 84. Brain magnetic resonance imaging was unremarkable. Ultrasound showed high-grade stenosis of the left internal carotid artery (ICA). Intracranial magnetic resonance angiogram showed stenosis of the A1 segment of the left anterior cerebral artery (ACA). Cerebral angiogram confirmed severe stenosis of the left ICA with a string sign. The left sided injection filled very few branches of the left middle cerebral artery. The left ACA filled from the right via the anterior communicating artery.Patients:1 patient, a 59 year old man. Dropout due to side effect.TypeofStudy:Recurrent orthostatic numbness associated with Lopresor. A case report.DosageDuration:50 mg bid (=100 mg daily) increased first to 75 mg bid (=150 mg daily) and then to 100 mg bid (=200 mg daily). Duration not stated.

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Journal of Stroke and Cerebrovascular Diseases







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