The syndrome of irreversible lithium-effectuated neurotoxicity: Clinical case and review

Abstract

Introduction

Lithium is a mood stabilizer used in the treatment of bipolar disorder. Lithium has recently been associated to permanent neurological damage namely persistent cerebelar dysfunction as well as peripheral and central neuropathies.

Objectives

To present a clinical case of a probable Syndrome of Irreversible Lithium-effectuated Neurotoxicity (SILENT) and a review of the literature concerning this rare syndrome.

Aims

Increase awareness and knowledge of SILENT.

Methods

Psychiatric and psychological evaluation of a probable clinical case of SILENT and review of the literature using the key words “lithium neurotoxicity” and “Syndrome of Irreversible Lithium-effectuated Neurotoxicity”.

Results

A 54-year-old female patient was admitted in our hospital due to involuntary lithium intoxication, with acute renal and cardiovascular failure, neurological, metabolic and electrolytic dysfunction in an acute confusional state and in need of dialysis. The patient clinical picture rapidly improved although, when she achieved normal lithium seric levels, it was observed a worsening of the preexisting confusional state followed by two consecutive generalized tonic-clonic convulsions and a partial convulsion. A short time after, it was recognized the development of a persistent catatonic state. It was detected urinary incontinence and repetitive, monosyllabic, incoherent, short phrased speech featuring echolalia, together with emotional lability and incongruous affect. The patient slightly improved with the introduction of anti-Parkinson's pharmacotherapy.

Conclusions

This clinical case raises several differential diagnoses due to its psychiatric and neurologic characteristics. We conclude that the most probable diagnosis is SILENT.

Disclosure of interest

The authors have not supplied their declaration of competing interest.