Tardive Tourette syndrome is characterized by the occurrence of multiple motor and vocal tics in patients on long-term neuroleptic, antiepileptic medication or stimulants, and was first reported by Golden in 1974 and was given its name in 1980 by Steven Stahl who linked it to tardive dyskinesia. The Medline was searched with the combination of the words 'tardive' or 'induced' or 'late' and 'Tourette' or 'Tourettism' and 375 papers were indentified; 42 of them were judged to be relevant. Forty-one cases were identified, caused by antipsychotics, antiepileptics, stimulants and other medication. A number of treatment options are reported in the literature but no systematic study of the syndrome has been done yet.
AbstractWe report a case of a 63-year-old male who has been admitted to the Emergency department with nonspecific symptoms. Lithium toxicity was not at first recognized. When we obtained sufficient information about previous medication and medical history, we measured lithium levels found to be 1.46 mmol/L. Although the value of lithium was mildly elevated, nephrotoxicity was produced leading to severe renal insufficiency and neurological symptoms. Hemodialysis was started, and we succeed to treat the patient without squeals. This case illustrates some of the factors that lead to lithium toxicity as well as the need to consider lithium toxicity to the differential diagnosis of a patient presenting with renal insufficiency with or without change in mental status and neurologic symptom.
IntroductionThe diagnosis of Parkinson's disease is mainly clinical. DaT SCAN may help in difficult cases. Depression is also a clinical diagnosis and is common and persistent symptom in Parkinson's disease. Dementia is very often in Parkinson's disease, but usually not at the first stages. The treatment of each of the above symptoms is difficult and a lot of times individualized.Case PresentationFemale 64 years old patient with history of hypothyroidism, depression and anxiety disorder was examined at outpatient Memory and Dementia clinic of 3rd Department of Neurology. The patient's major problems were functional and cognitive decline, severe extrapyramidal symptoms and depression. According to UKPDS Brain Bank criteria the patient had bradykinesia, muscular rigidity, postural instability and rest tremor present with unilateral onset of the symptoms affecting left side most and progressive course. The modified Hoehn and Yahr scale was 3: mild to moderate bilateral disease; some postural instability; physically independent. The symptoms remained during nine months follow up, despite the pharmaceutical treatment. Nine months later, the patient made an attempt to suicide. Firstly, she was transferred to intensive care department with 2nd degree burns and respiratory problems, then she was hospitalized at the Burn Unit and afterwards at the Psychiatric clinic. One month later the patient had no depression, a clear reduction of the extrapyramidal symptoms, functional and cognitive improvement.ConclusionAn astonishing improvement occurred after the threat of life. Two years after the attempt to suicide, the depressive symptoms remain in remission and functional and cognitive status is normal. The extrapyramidal symptoms have disappeared.
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