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Timeline and clinical course of the patient. The neuroleptic malignant syndrome symptoms disappeared after discontinuing lithium treatment, by 14 and 10 days, respectively
Source publication
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...
Contexts in source publication
Context 1
... 1 A 28-year-old woman, who had schizophrenia since 2014, was referred to the emergency department in an altered mental state. She had been taking lithium at 1200 mg/day for 4 years: quetiapine at 400 mg/day, clonazepam at 0.5 mg/day, and risperidone at 5 mg/day for several months (Fig. 1). The lithium dosage was increased to 1800 mg/day, 12 days before admission, due to her disoriented speech and aggressive behavior. The patient was referred to our hospital after 2 days of generalized tremor, rigidity, dysarthria, high fever (38 °C), and tachycardia (120 beats/min). Vital signs at admission included blood pressure at ...
Context 2
... since 1988, was referred to the hospital due to impatience and aggressive behavior. As treatment with lorazepam 0.5 mg/ day, haloperidol 5 mg/day, trazodone 25 mg/day, and zotepine 50 mg/day for 2 days was insufficient in controlling her symptoms of hyperactivity with grandiosity and decreased need for sleep. Lithium (1200 mg/day) was added ( Fig. 1). Two days later, her mental capacity declined. After 7 days, she developed fever (38 °C) and generalized tremor in both the arms and legs. Her blood pressure, heart rate, and respiration rate were 150/100 mmHg, 80 beats/min, and 20 breaths/min, respectively. Laboratory investigations revealed mild leukocytosis but no other specific ...
Citations
... With regard to the differential diagnosis, it is important to consider the potential association between lithium, psychotropic drugs, and MERS. Ryu et al. suggested a crucial role of lithium intoxication in the development of RSL, as the clinical symptoms coincided with the initiation of lithium treatment and resolved upon the tapering of lithium, even when the lithium blood concentration was within the lower therapeutic range (0.3 mEq/L) in their reported case (11). In contrast, the present case exhibited an even lower blood lithium concentration in comparison to their case. ...
A 47-year-old woman with a history of substance abuse, depression, and insomnia experienced a collapse. Upon arrival at the hospital, the patient displayed low systolic blood pressure, confusion, dehydration, and renal failure. Urine tests confirmed an amphetamine and opioid overdose. Her condition fluctuated with reduced consciousness, myoclonic movements, fever, and suspected psychogenic seizures. Brain magnetic resonance imaging revealed abnormalities in the splenium of the corpus callosum, which later resolved. The patient's condition gradually improved without any specific treatment. This unique case represents the first report of mild encephalopathy/encephalitis with reversible splenial lesions associated with amphetamine and opioid use.
... Xu et al. (6) suggested that RESLES might only show mental symptoms and in their research, all patients showed different mental disorders as the only manifestation with different diagnosis (MDD, dissociative and conversion disorders, undifferentiated somatoform disorder, unspecified psychosis and BD). A recent case reported two patients of RESLES with lithium-associated neurotoxicity while they were diagnosis as schizophrenia and BD, respectively (7). Although the underlying pathophysiology of RESLES is not yet well understood, studies have indicated that it is related to inflammation, intramyelinic cytotoxic edema (8), oxidative stress (9), and autoimmune processes (10). ...
Background
Reversible splenial lesion syndrome (RESLES) is a rare neurological condition characterized by temporary abnormalities in the splenium of the corpus callosum, which has been reported in mental disorders. Previous studies on bipolar disorder (BD) primarily focused on aspects such as brain structure and function, neurochemical changes, and genetics. However, there have been no studies reporting the occurrence of this syndrome during hypomanic episodes and its disappearance during the remission phase in bipolar disorder type 2 (BD-II).
Case presentation
We present a case report of a 30 years-old female patient with BD-II who exhibited symptoms of RESLES during a hypomanic episode. The patient, with a 12 years psychiatric history, has experienced recurrent depressive episodes initially, with the first hypomanic episode occurring 8 years ago. During this period, this patient made several visits to the outpatient clinic to have her medications adjusted due to repeated suicide attempts. This time, she was admitted to our hospital with a second hypomanic episode due to drug withdrawal during pregnancy. The RESLES was observed on her brain magnetic resonance image, and it was alleviated after treatment with lithium carbonate and quetiapine until achieving remission.
Conclusion
We present the first report of identifying RESLES in BD-II with hypomanic episodes, which subsequently disappears during the remission phase. Our case report highlights a potential association between BD and RESLES, emphasizing the need for future studies to explore the underlying mechanisms connecting these two conditions in greater depth.
... For instance, Li has a promotion effect on the agonist-dependent metabolism of inositol phosphate and a significant effect on controlling mania and depression [61,62], but its mechanism of action has remained elusive until now. Lithium medication has benefits, but its benefits are difficult to be utilized due to a restricted therapeutic window and neurological side effects, which can easily lead to neurological toxicity [63,64]. Low levels of lithium in humans have been reported to be associated with a variety of behavioral problems, including aggression and decreased sociability [65,66]. ...
Existing data demonstrate a significant correlation between autism spectrum disorder (ASD) and the status of biologically essential and toxic trace elements. However, there is still a lack of data on the steady state of trace elements in ASD. We performed a case–control study to explore the association between the risk of ASD and 23 trace elements in plasma. The results showed that children with ASD had considerably decreased lithium (Li), manganese (Mn), selenium (Se), barium (Ba), mercury (Hg), and tin (Sn) levels when compared to their age- and sex-matched controls. Meanwhile, children with ASD had considerably increased plasma chromium (Cr) and vanadium (V) concentrations. We also divided each group into subgroups based on age and gender and created element-related networks for each subgroup. We detected significant element correlations within or between subgroups, as well as changes in correlations that included all elements examined. Finally, more element correlations were observed among males, which may open a new avenue for understanding the complicated process behind the sex ratio of children with ASD. Overall, our data revealed a novel relationship between elements and ASD, which may extend current understanding about ASD.
... 6 At the time of writing, only 7 publications exist documenting ILSCC in the context of NMS, the first of which was published in 2009. [7][8][9][10][11][12][13] In this report, we are the first to describe a case of atypical NMS presenting with an ILSCC. We are also the first to publish a case report to postulate a possible pathophysiological relationship between the development of ILSCC and NMS. ...
... At the time of writing, this is only the eighth documented case demonstrating concurrent ILSCC and NMS pathology. [7][8][9][10][11][12][13] NMS has phenotypic heterogeneity and should be viewed on a disease spectrum rather than as a discrete syndrome. 3 Fever and autonomic instability are usually late findings in NMS, which can make identifying early presentations of NMS especially challenging. ...
... 19 Prior reports have shown a complete resolution of the MRI lesion within 2 to 12 weeks. [7][8][9][10][11][12][13] In this case, imaging at 11 days showed a persistent lesion. Consequently, it remains possible that if reimaged later on, our patient's lesion may have been found to be transient as in the previously documented cases. ...
In this report, we describe a case of atypical neuroleptic malignant syndrome (NMS) presenting with an isolated lesion in the splenium of the corpus callosum (ILSCC). There is a paucity of information regarding this topic within the literature and only 7 previous case reports have been published at the time of writing. To our knowledge, this case report is also the first to describe an atypical NMS variant in the context of an ILSCC. In this report, we describe the important considerations in formulating differential diagnosis for ILSCC and are the first report to propose a possible pathophysiological mechanism relating ILSCC with NMS.
Background: The female reproductive organs include uterus, fallopian tubes and ovaries, these organs when exposed to drugs and metals lead to anatomical damage resulting in infertility. Researchers have documented the harmful effects of the favorable antidepressant Lithium Carbonate on many human viscera’s but even today the medicinal world has scarce knowledge of the ablation of ovarian anatomy by lithium carbonate. Aim: To study and document the results of the detrimental effects of Lithium on the ovaries. Methods: We selected Twenty four adult female rats for this observational and experimental study. The female albinos were divided into two groups. Twelve animals were present in Group A and Group B consisted of twelve female rats. The hygienically prepared laboratory diet which consisted of flour pellets and green vegetables was given to Group A animals and Group B rodents received Lithium carbonate in powder form for eight weeks. After completion of the study time animals were sacrificed and weight of ovaries were recorded and compared in both groups. Results: The results in Group B documented that animals had a highly significantly decline in ovarian weight after chronic Lithium carbonate than in Group A. Conclusion: Our prospective study concluded that chronic administration of Lithium Carbonate causes distortion of its tissue and highly significant decrement of weight of the ovary. Keywords: Ovary, decrement, infertility
Side Effects of Drugs Annual is an annual publication that publishes side effects, adverse reactions and toxicities associated with medications. The series supplements the contents of Meyler's Side Effects of Drugs: The International Encyclopedia of Adverse Drug Reactions and Interactions. Though lithium has an extensive history in the treatment of bipolar disorder, case reports, reviews, and meta-analyses continue to address the drug's adverse effects. The remaining sections of the chapter will highlight international reports of adverse effects detailed in the literature from January 1, 2020 through December 31, 2020 and will be discussed as a systems-based approach. Lithium pharmacogenomics and toxicologic profile are included. Analysis of the literature from the past year resulted in a substantial amount of research and reports regarding the properties and side effects profile of lithium. The overall goal of this chapter is to make healthcare professionals aware of adverse effects associated with lithium use and improve management of patients who suffer from these adverse effects.
