Symptoms of the wobbliness
DEAR DR. ROACH >>
I am an almost 70-year-old male. I’m 6 feet and 2 inches tall, and I weigh 174 pounds. I quit smoking in May 1988. I drink little to no alcohol (although I have had periods of moderate to heavy use in my life).
I have been a runner and moderate strength trainer since the mid1980s and ran a marathon in 2009. I lift about 2/3s to 3 /4s of my weight on several machines. I do a set of 20 repetitions, add weight, then do 10 reps, add more weight, then do five reps. I have dealt with atrial fibrillation (Afib) since February 2017 and have been on Eliquis since that time. I have also had three cardiac ablations, the most recent in January 2023. My current anti-arrhythmic medication is Multaq. I also take a statin, and my Afib is well-controlled.
About two years ago, right around the time I had an appendectomy, a subsequent pelvic abscess, and my first two ablations, I started getting somewhat wobbly on my feet. It feels as if the floor is tilted rather than dizziness. Some days are better than others, and reducing coffee intake helps somewhat. Despite the gait issues (tilted floor and lack of smoothness in leg motion), I can still run and exercise, albeit with more concentration on where my feet are going.
My general physician recently ordered brain and spine MRIS for me. The brain MRI shows evidence of past hemorrhages, one in the right occipital lobe and one on the left cerebellum. My cardiologist noticed this on a recent visit and wants me to have an MRA (magnetic resonance angiography) to be certain that it is still safe for me to be on an anticoagulant. No one has told me to cease running or strength training.
Could these hemorrhages, especially the one in the cerebellum, be causing my ataxia? Should I refrain from vigorous exercise until I have the MRA?
DEAR READER >>
— M.R.
This is an issue of competing risks. Because you have Afib, you take Eliquis to reduce your risk for a stroke due to a blood clot forming in the heart. You also take a statin, which reduces the risk of heart attacks and embolic and thrombotic strokes. However, both Eliquis and the statin increase the risk of a hemorrhage in the brain.
The MRI you sent me is pretty definitive that you have had two separate hemorrhages in the brain, and I do believe that the findings on the MRI could correlate with your symptoms of ataxia (poor muscle control, which causes clumsiness). A neurologist is an essential consultant at this time.
Exercise is generally an excellent idea after any kind of stroke. However, after a hemorrhagic stroke in particular, you want to avoid high amounts of weight that can affect blood flow to the brain and pressure inside the brain. While you wait for your personalized recommendations from the neurologist, one recommendation that I read is not to exceed 50% of your one-repetition maximum and do 1-3 sets of 8-15 repetitions. Running at a moderate intensity (20-60 minutes three to five days a week) is also OK.
The association between the symptom onset and your various medical procedures suggests to me that the bleed into your brain happened then, under additional stress. But ideally, after you get your planned MRA, your cardiologist and neurologist should confer to decide on the right medications to minimize the risk of an embolic stroke from Afib and the risk of stroke due to hemorrhages.
Contact Dr. Roach at Toyourgoodhealth@med. cornell.edu.
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