Asunto(s)
Infarto Encefálico/inducido químicamente , Bupropión/envenenamiento , Sobredosis de Droga/complicaciones , Hipocampo/diagnóstico por imagen , Síndrome de la Serotonina/inducido químicamente , Clorhidrato de Vilazodona/envenenamiento , Adolescente , Infarto Encefálico/diagnóstico por imagen , Sobredosis de Droga/diagnóstico por imagen , Fiebre/inducido químicamente , Fiebre/diagnóstico por imagen , Alucinaciones/inducido químicamente , Alucinaciones/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Masculino , Pruebas Neuropsicológicas , Síndrome de la Serotonina/diagnóstico por imagen , Temblor/inducido químicamente , Temblor/diagnóstico por imagenRESUMEN
BACKGROUND: Serotonin syndrome (SS) is a potentially life-threatening condition that can be caused by use of proserotonergic drugs. Several studies have reported that combined administration of various medications may induce SS. We report a case of SS in a patient who was being treated with dopaminergic and noradrenergic drugs. CASE PRESENTATION: A 55-year-old man with a right frontal intracerebral hemorrhage extending to the left cerebral hemisphere presented with clinical features of akinetic mutism. Three months after onset, dopaminergic (methylphenidate, levodopa/benserazide) and noradrenergic (atomoxetine) drugs were administered to enhance his cognitive function. His cognitive function gradually improved during 8 weeks of dose escalation. One day after the dose of atomoxetine was increased from 40 mg/d to 60 mg/d, the patient developed inducible clonus, rigidity, diarrhea, tachycardia, and hyperthermia, in keeping with a diagnosis of SS. The symptoms and signs suggestive of SS resolved on the day following cessation of all dopaminergic and noradrenergic drugs. CONCLUSIONS: This case demonstrates that medications generally known as dopaminergic or noradrenergic agents could have serotonergic effects via a mechanism that is yet to be fully elucidated. The clinical manifestations of SS can be diverse, ranging from mild to severe and potentially fatal symptoms. When administering a combination of catecholaminergic agents, clinicians should carefully monitor the patient's neurologic status for unexpected adverse reactions.
Asunto(s)
Inhibidores de Captación Adrenérgica/efectos adversos , Mutismo Acinético/diagnóstico por imagen , Hemorragia Cerebral/diagnóstico por imagen , Inhibidores de Captación de Dopamina/efectos adversos , Síndrome de la Serotonina/diagnóstico por imagen , Inhibidores de Captación Adrenérgica/administración & dosificación , Mutismo Acinético/tratamiento farmacológico , Mutismo Acinético/etiología , Clorhidrato de Atomoxetina/administración & dosificación , Clorhidrato de Atomoxetina/efectos adversos , Benserazida/administración & dosificación , Benserazida/efectos adversos , Hemorragia Cerebral/complicaciones , Hemorragia Cerebral/tratamiento farmacológico , Dopaminérgicos/administración & dosificación , Dopaminérgicos/efectos adversos , Inhibidores de Captación de Dopamina/administración & dosificación , Combinación de Medicamentos , Quimioterapia Combinada , Humanos , Levodopa/administración & dosificación , Levodopa/efectos adversos , Masculino , Metilfenidato/administración & dosificación , Metilfenidato/efectos adversos , Persona de Mediana Edad , Síndrome de la Serotonina/inducido químicamente , Síndrome de la Serotonina/complicacionesRESUMEN
INTRODUCTION: Methylene blue (MB) infusion is frequently used to localize the parathyroid glands during parathyroidectomy and generally considered safe. Several recent reports suggest neurological toxicity and post-operative altered mental state typically after large dose infusions. The mechanism by which MB has neurotoxic effects in some patients remains uncertain. CASE REPORT: A 67-year-old male underwent lumbar laminectomy followed by parathyroidectomy. Postoperatively, he was comatose (Glasgow Coma Scale of 7) and underwent extensive neurological evaluation. Brain computed tomography (CT) imaging and CT angiography revealed no ischemia, vessel occlusion, or hemorrhage. Electroencephalogram (EEG) showed only slowing of cerebral hemispheric activity bilaterally. Over the next 48 h, his mental status slowly improved and the patient made a full neurological recovery (Glasgow Coma Scale 15). CONCLUSION: Methylene blue, when used in patients on antidepressant drugs, may be associated with a transient encephalopathic state and serotonin syndrome. Patients on antidepressants undergoing parathyroidectomy who may receive MB infusion should be considered for alternative parathyroid gland identification or discontinuation of the antidepressants before surgery. MB-associated serotonin syndrome is an increasing and under recognized ('green') post-operative encephalopathy that warrants education to critical care neurologists and other physicians.