A case of alcoholic hypokalemic myopathy with motor hemiparesis

Abstract

We present an extremely rare case of a hypokalemic myopathy with motor hemiparesis that is a stroke-like episode indicating rt-PA therapy, although the hypokalemic myopathy often causes tetraparesis. A 69-year-old man was admitted to our hospital with sudden right motor hemiparesis. He did not have any particular past histories, except for a habit of drinking. Hemiparesis caused by acute stroke was suspected in the primary diagnosis, but any ischemic and hemorrhagic lesions could not be detected in both magnetic resonance imaging (MRI) and CT. The laboratory analysis showed that the level of potassium in serum (K⁺) was decreased to 1.8 mEq/l and CPK was abnormally elevated to 2,403 U/l. We diagnosed him with a hypokalemic myopathy like stroke mimics. His motor weakness had gradually recovered with an improving K⁺ level. In the present case, the myopathy should be caused by alcoholic hypokalemia because the alcoholic drinker tends to develop chronic hypokalemia. The presence of electrolyte imbalance should be considered, especially when the patient with alcoholism behavior complaint of symptoms like stroke.