Persistent cerebellar syndrome due to lithium treatment: a case report

Öz

We report the case of a 23-year-old man with bipolar disorder who developed permanent cerebellar damage of lithium intake within therapeutic ranges. Cerebellar symptoms such as dysarthria, ataxia, and tremor developed 1 year after the beginning of lithium. Two years later, cerebellar signs and symptoms were found to be permanent in the patient. Cerebellar syndrome was most probably due to lithium neurotoxicity, which was associated with the administration of antipsychotic.

Anahtar Kelimeler

• lithium, Cerebellar syndrome, permanent neurotoxicity

Lityum tedavisine bağlı gelişen kalıcı serebellar sendrom: Olgu sunumu

Öz

Bu yazımızda iki uçlu bozukluğu olan 23 yaşındaki bir erkek hastada normal aralıktaki serum lityum düzeylerine rağmen kalıcı serebellar sendrom gelişen bir olguyu sunduk. Lityum tedavisi başlanmasından 1 yıl sonra hastada dizartri, ataksi, tremor gibi serebellar bulgular gelişti. 2 yıl sonra, hastanın serebellar bulgularının kalıcı olduğu gözlendi. Olgumuzda gelişen serebellar sendrom en büyük olasılıkla lityum tedavisiyle birlikte antipsikotik kullanılmasına bağlıdır.

Anahtar Kelimeler

• lityum, serebellar sendrom, kalıcı nörotoksisite

Kaynakça

1. Meltzer E, Steinlauf S. The clinical manifestations of lithium intoxication. Isr Med Assoc J 2002;4:265-7.
2. Peces R, Fernández EJ, Regidor D, Peces C, Sánchez R, Montero A, Selgas R. Treatment of acute lithium intoxication with highflux haemodialysis membranes. Nefrologia 2006;26:372-8.
3. Ozsoy S, Basturk M, Esel E. Cerebellar syndrome in a patient with pneumonia under lithium treatment: A case report. Prog Neuropsychopharmacol Biol Psychiatry. 2006;30:1532-4.
4. Jaeger A. Lithium. Medicine 2007;35:535-6.
5. Niethammer M, Ford B. Permanent lithium-induced cerebellar toxicity: Three cases and review of literature. Movement Disorders 2007;22:570-3.
6. Adityanjee M, Kaizad R, Thampy A. The syndrome of irreversible lithium-effectuated neurotoxicity. Clin Neuropharmacol 2005;28:38-49.
7. Porto FHG, Leite MAA, Fontenelle LF, Marrocos RP, Szczerback NF, de Freitas MRG. The Syndrome of Irreversible LithiumEffectuated Neurotoxicity (SILENT): One-year follow-up of a single case. Journal of the Neurological Sciences 2009;277:172-3.
8. Bejot Y, Depierre P, Osseby GV, Troisgros O, Moreau T, Giroud M. Central pontine and extra-pontine myelinoysis: a complication of lithium toxicity in a pregnant woman. Clin Neurol Neurosurg 2008;110:852-4.

9. Grignon S, Bruguerolle B. Cerebellar lithium toxicity: a review of recent literature and tentative pathophysiology. Therapie. 1996;51:101-6.
10. Dixon JF, Los GV, Hokin LE. Lithium stimulates glutamate release and inositol 1,4,5-triphosphate accumulation via activation of the N-methyl-D-aspartate receptor accumulation in monkey and mouse cerebral cortex slices. Proc Natl Acad Sci USA 1994; 91:8358-62.
11. Apte SN, Langston JW. Permanent neurological deficits due to lithium toxicity. Ann Neurol 1983;13:453-5.
12. Lenox RH, Manji HK. Lithium. In Textbook of Psychopharmacology (Eds AF Schatzberg, CB Nemeroff): 303-349. Washington DC, American Psychiatric Press, 1995.
13. Andreazza AC, Kauer-Sant’Anna M, Frey BN, Stertz L, Zanotto C, Ribeiro L et al. Effects of mood stabilizers on DNA damage in an animal model of mania. J Psychiatry Neurosci 2008;33:516-24.
14. Kesebir S, Üstündağ MF, Kavzoğlu SÖ. Lityum Zehirlenmesi. Psikiyatride Güncel Yaklaşımlar 2011;3:426-45.
15. Heurteaux C, Ripoll C, Ouznadji S, Wissocg JC, Thellier M. Brain Res 1991;547:122-8.
16. Jefferson JW. Rediscovering the art of lithium therapy. Curr Psychiatry 2002;1(12).
17. Sadosty AT, Groleau GA, Atcherson MM. The use of lithium levels in the emergency department. J Emerg Med 1999;17:887-91.
18. Cerqueira AC, Reis MC, Novis FD, Bezerra JM, Magalhães GC, Rozenthal M, Nardi AE. Cerebellar degeneration secondary to acute lithium carbonate intoxication. Arq Neuropsiquiatr. 2008; 66:578-80.
19. Emilien G, Maloteaux JM. Lithium neurotoxicity at low therapeutic doses: hypotheses for causes and mechanism of action following a retrospective analysis of published case reports. Acta Neurol Belg 1996; 96:281-93.
20. Roy M, Stip E, Black D, Lew V, Langlois R. Cerebellar degeneration following acute lithium intoxication. Rev Neurol 1998; 154:546-8.