Why your shaky hands could be a warning sign you have had a ‘silent’ stroke: DR MARTIN SCURR reveals exactly when to demand a referral to a neurologist
Earlier this year my hand started to shake, and then my arm. After an MRI scan I was diagnosed with spondylosis. I’ve been given physio exercises which help with the neck stiffness I also have. Can I expect the shakiness to disappear?
A. Merriman, Northampton.
Dr Martin Scurr replies: Spondylosis is the medical term for wear and tear in the spine – you have a form known as cervical spondylosis, affecting the joints and discs (which cushion the bones) in the neck.
This typically causes neck pain and stiffness. Age-related wear and tear can irritate the joints and tissues in the neck, leading to inflammation and reduced movement.
Some patients also experience symptoms in the arm and hand, such as tingling and numbness, if nerves in the neck become pinched – but it does not cause the kind of tremor or shakiness you describe.
My question is whether the tremor occurs when you’re not using your hand or arm, or whether it is during movement.
If it is the latter, then it could be a sign of essential tremor. This is a common neurological disorder thought to be caused by malfunction of the brain cells that control movement and typically affects the hands.
Although it usually affects both hands, the severity can be unequal, so you might feel it in one hand but not the other. Treatment for this starts with medication such as anti-seizure drugs.
Holmes tremor, which can affect one hand and arm, occurs when at rest then becomes more evident during movement. This can follow a minor stroke and will often occur many months later (picture posed by model)
Another form of tremor affecting one hand and arm, Holmes tremor, occurs when at rest, then becomes more evident during movement. This can follow a minor stroke (which can be so slight that people might not realise they’ve experienced one) and will often occur many months later.
Other movement conditions can cause such symptoms, too.
I’d advise that you ask for a referral to a neurologist – please do write to me and let me know what their opinion is.
What’s causing my low blood pressure (105/55, sometimes 98/48) and skipped heartbeats (which are worse upon exhaustion)? This makes me feel faint, especially first thing in the morning. After a heart attack 20 years ago, I had a bypass operation and now take aspirin, ramipril, a statin and rabeprazole. This problem has been going on for a few months. Should I be worried?
D. Thomas, Cornwall.
Dr Martin Scurr replies: In someone in their 20s or 30s those blood pressure readings could be regarded as healthy – so, too, in someone older, unless they have symptoms, such as those you describe. This is known as symptomatic hypotension.
I think in your case it relates to the ramipril you’re taking, probably for hypertension – high blood pressure. You might have become oversensitive to it.
The morning faintness is a sign of postural hypotension – a drop in blood pressure on standing. Becoming dehydrated overnight will also contribute to the effect of ramipril.
The skipping of your heartbeat is a sign of either premature atrial or ventricular heartbeats – essentially the upper or lower chambers of the heart aren’t beating in a regular way. The ‘missed’ beat you notice is the pause following an extra beat.
This can often be entirely innocent but can also occur as a result of damage from a heart attack, for instance, affecting the heart’s electrical activity.
It would be sensible for you to see your GP for an electrocardiogram (ECG) to check your heart, and for a blood pressure check when you’re lying down and then standing. (If they can’t do an ECG at the practice, then you’ll be referred to a hospital cardiology department.)
Treatment would involve adjusting your blood pressure medication – or even stopping it.
In the meantime, I’d advise against strenuous exercise.
You say in your longer letter you take salt to raise your blood pressure, but I’d not do this until your heart is checked (and you’ll also need a blood test to measure your kidney function). It’s also important to keep taking the ramipril unless your doctor’s advice changes.
In my view… Patients will suffer when doctors strike
I was shocked by the news that hospital consultants are set to strike – with average annual earnings topping £150,000-plus and the fact that they get an NHS pension, there’s not much to sympathise with.
And indeed, when I asked a group of them about it they rolled their eyes: none feels good about it, yet they all feel they must show solidarity.
Essentially, NHS consultants in England want parity with their colleagues in Wales, whose final pay point is £16,000 higher than theirs. Those in Wales also work a shorter 37-and-a-half-hour week compared with England’s 40. Consultants in England are now calling for a 35-hour working week.
Their Welsh colleagues also get almost double the amount of time off from clinical duties for doing admin and other activities such as teaching.
Whether you think this is a striking matter or not, when you have the British Medical Association on one side and the Department of Health and Social Care (mainly working from home?) on the other, you worry about who the grown-up in the room is.
Meanwhile, patients are inevitably going to suffer.
Write to Dr Scurr at Good Health, Daily Mail, 9 Derry Street, London, W8 5HY or email drmartin@dailymail.co.uk. Replies should be taken in a general context. Always consult your own GP with any health concerns.
