ABSTRACT. Rapidly progressive dementia (RPD) is a rare neurological disorder. Drug toxicity is among the differential diagnoses, including the use of lithium, in which an overdosage might cause cognitive dysfunction. Clinical suspicion, laboratory confirmation, and drug interruption are key points in the management of lithium intoxication. We described a 66-year-old female patient under treatment with lithium who developed an RPD associated with parkinsonian symptoms. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) showed an “Alzheimer-like” pattern, while cerebrospinal fluid biomarkers for the disease were negative. There was a significant clinical and radiological improvement after lithium interruption. Lithium intoxication is a potentially reversible cause of RPD, as demonstrated in this case report. Drug discontinuation should be considered even in patients with normal levels of this metal, if cognitive impairment is detected. 18F-FDG PET/CT images may show an “Alzheimer-like” image pattern in acute intoxication and are useful for monitoring these patients.
The deposition of iron in the basal ganglia is an age-dependent physiological event, however, increased deposits has been shown in the central nervous system in many neurodegenerative diseases (including Friedreich's Ataxia-FA, Machado-Joseph Disease-MJD, Amyotrophic Lateral Sclerosis-ALS and Parkinson's Disease-PD) and, in this context, the use of Magnetic Resonance Imaging (MRI) trhough the analyses of transversal relaxation time (RT2) can be a powerfull diagnostic tool by the detection of brain iron deposits. We selected 191 patients (32 AF, 48 MJD, 58 ALS, 53 PD) and compared four structures of basal ganglia (thalamus, dentate nucleus, pallidum and substantia nigra) RT2 values with control group (n = 207, using normal values from previous study of the same group of researchers), trying to determine paterns of brain iron depositions that can be used as diagnostic tool. We found statistically significance in the avaliation of left dentate nucleus in FA patients (p = 0,03), rght substantia nigra in MJD (p = 0,01) and left thalamus in ALS (0,01), with probable physiopathological and clinical correlations. The RT2 MRI is a relevant technique in the evaluation of neurodegenerative diseases and can be used as an important diagnostic tool in the clinical practice.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.