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Lithium induced reversible Splenial lesion in neuroleptic malignant syndrome like symptoms: two case reports

BACKGROUND: Lithium is primarily used to treat bipolar disorder and is known to cause several acute neurological complications. Reversible splenial lesions (RSLs) may be evident in antiepileptic drug toxicity or withdrawal, infections, and other phenomena. We report two cases of RSL presenting as ne...

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Autores principales: Ryu, Han Uk, Chung, Ji Yeon, Shin, Byoung-Soo, Kang, Hyun Goo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7193363/
https://www.ncbi.nlm.nih.gov/pubmed/32354328
http://dx.doi.org/10.1186/s12883-020-01742-z
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author Ryu, Han Uk
Chung, Ji Yeon
Shin, Byoung-Soo
Kang, Hyun Goo
author_facet Ryu, Han Uk
Chung, Ji Yeon
Shin, Byoung-Soo
Kang, Hyun Goo
author_sort Ryu, Han Uk
collection PubMed
description BACKGROUND: Lithium is primarily used to treat bipolar disorder and is known to cause several acute neurological complications. Reversible splenial lesions (RSLs) may be evident in antiepileptic drug toxicity or withdrawal, infections, and other phenomena. We report two cases of RSL presenting as neuroleptic malignant syndrome-like symptoms (NMSLS) with lithium associated neurotoxicity. CASE PRESENTATION: A 28-year-old woman was admitted after taking increased dosages of lithium for schizophrenia. She experienced generalized tremor, rigidity, dysarthria, high fever, and tachycardia. Symptoms and brain lesion recovered 2 weeks after discontinuation of lithium. The second case involved a 59-year-old woman who was receiving treatment for bipolar disorder since 1988. When lithium was administered for impatience and aggressive behavior, her mental state deteriorated and fever developed, along with generalized tremor in the extremities. Brain magnetic resonance imaging (MRI) in both patients showed a reversible oval-shaped lesion localized to the splenium of the corpus callosum. Both patients were defined as neuroleptic malignant syndrome-like symptoms (NMSLS) based on the DSM-5 diagnostic criteria for neuroleptic malignant syndrome. The suspected etiology of our cases was lithium associated neurotoxicity according to their clinical course and medical information. Our patients fully recovered in 10–14 days after the discontinuation of lithium. CONCLUSIONS: The patients experienced similar clinical courses and had similar radiological findings of RSL. Manifestations in both cases were related to lithium associated neurotoxicity and this should be considered in patients with RSL and NMSLS.
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spelling pubmed-71933632020-05-06 Lithium induced reversible Splenial lesion in neuroleptic malignant syndrome like symptoms: two case reports Ryu, Han Uk Chung, Ji Yeon Shin, Byoung-Soo Kang, Hyun Goo BMC Neurol Case Report BACKGROUND: Lithium is primarily used to treat bipolar disorder and is known to cause several acute neurological complications. Reversible splenial lesions (RSLs) may be evident in antiepileptic drug toxicity or withdrawal, infections, and other phenomena. We report two cases of RSL presenting as neuroleptic malignant syndrome-like symptoms (NMSLS) with lithium associated neurotoxicity. CASE PRESENTATION: A 28-year-old woman was admitted after taking increased dosages of lithium for schizophrenia. She experienced generalized tremor, rigidity, dysarthria, high fever, and tachycardia. Symptoms and brain lesion recovered 2 weeks after discontinuation of lithium. The second case involved a 59-year-old woman who was receiving treatment for bipolar disorder since 1988. When lithium was administered for impatience and aggressive behavior, her mental state deteriorated and fever developed, along with generalized tremor in the extremities. Brain magnetic resonance imaging (MRI) in both patients showed a reversible oval-shaped lesion localized to the splenium of the corpus callosum. Both patients were defined as neuroleptic malignant syndrome-like symptoms (NMSLS) based on the DSM-5 diagnostic criteria for neuroleptic malignant syndrome. The suspected etiology of our cases was lithium associated neurotoxicity according to their clinical course and medical information. Our patients fully recovered in 10–14 days after the discontinuation of lithium. CONCLUSIONS: The patients experienced similar clinical courses and had similar radiological findings of RSL. Manifestations in both cases were related to lithium associated neurotoxicity and this should be considered in patients with RSL and NMSLS. BioMed Central 2020-04-30 /pmc/articles/PMC7193363/ /pubmed/32354328 http://dx.doi.org/10.1186/s12883-020-01742-z Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Case Report
Ryu, Han Uk
Chung, Ji Yeon
Shin, Byoung-Soo
Kang, Hyun Goo
Lithium induced reversible Splenial lesion in neuroleptic malignant syndrome like symptoms: two case reports
title Lithium induced reversible Splenial lesion in neuroleptic malignant syndrome like symptoms: two case reports
title_full Lithium induced reversible Splenial lesion in neuroleptic malignant syndrome like symptoms: two case reports
title_fullStr Lithium induced reversible Splenial lesion in neuroleptic malignant syndrome like symptoms: two case reports
title_full_unstemmed Lithium induced reversible Splenial lesion in neuroleptic malignant syndrome like symptoms: two case reports
title_short Lithium induced reversible Splenial lesion in neuroleptic malignant syndrome like symptoms: two case reports
title_sort lithium induced reversible splenial lesion in neuroleptic malignant syndrome like symptoms: two case reports
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7193363/
https://www.ncbi.nlm.nih.gov/pubmed/32354328
http://dx.doi.org/10.1186/s12883-020-01742-z
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