Reversible Splenial Lesion Related to Acute Lithium Intoxication in a Bipolar Patient

Goto, Takashi; Ishitobi, Makoto; Higashima, Masato; Wada, Yasuhiko

doi:10.1097/jcp.0000000000000544

Cited by 6 publications

(5 citation statements)

References 11 publications

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“…Those cases suggested that lithium toxicity can occur neurotoxic effect with NMS, but none of them showed combined lesion of RLS. To our best knowledge, there has been only one RSL case reportedly related to lithium intoxication; the serum lithium level was in the upper limit of the normal range (0.94 mEq/L) and NMSLS was not present [10]. In both of our cases, the initial splenial lesion on MRI had disappeared upon follow-up examination, suggesting cytotoxic edema.…”

Section: Discussionmentioning

confidence: 49%

Lithium induced reversible Splenial lesion in neuroleptic malignant syndrome like symptoms: two case reports

et al. 2020

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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) with lithium associated neurotoxicity. Case presentation: A 28-year-old woman was admitted after taking increased dosages of lithium for schizophrenia. She experienced generalized tremor, rigidity, dysarthria, high fever, and tachycardia. Symptoms and brain lesion recovered 2 weeks after discontinuation of lithium. The second case involved a 59-year-old woman who was receiving treatment for bipolar disorder since 1988. When lithium was administered for impatience and aggressive behavior, her mental state deteriorated and fever developed, along with generalized tremor in the extremities. Brain magnetic resonance imaging (MRI) in both patients showed a reversible oval-shaped lesion localized to the splenium of the corpus callosum. Both patients were defined as neuroleptic malignant syndrome-like symptoms (NMSLS) based on the DSM-5 diagnostic criteria for neuroleptic malignant syndrome. The suspected etiology of our cases was lithium associated neurotoxicity according to their clinical course and medical information. Our patients fully recovered in 10-14 days after the discontinuation of lithium. Conclusions: The patients experienced similar clinical courses and had similar radiological findings of RSL. Manifestations in both cases were related to lithium associated neurotoxicity and this should be considered in patients with RSL and NMSLS.

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Section: Discussionmentioning

confidence: 49%

Lithium induced reversible Splenial lesion in neuroleptic malignant syndrome like symptoms: two case reports

et al. 2020

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“…The authors suspected that the etiology of RESLES was lithium-associated neurotoxicity, which was also associated with NMS symptoms. Moreover, interactions with other neuroleptic drugs may increase lithium-associated neurotoxicity and clinical symptoms [10,11]. In our case, the patient received increased doses of lithium with quetiapine and presented with NMS, which led to the development of RESLES.…”

Section: Discussionmentioning

confidence: 80%

“…To the best of our knowledge, this is the rst reported case of RESLES due to the ingestion of paracetamol. For lithium intoxication, three patients had previously been reported to be affected by RESLES [10,11]. The clinical manifestations of RESLES are diverse and atypical.…”

Section: Discussionmentioning

confidence: 99%

“…Lithium has a narrow therapeutic range, which may lead to neurological toxicity [10]. Previous studies have suggested that the neurotoxic effects of lithium are associated with NMS [10].…”

Section: Discussionmentioning

confidence: 99%

“…Lithium has a narrow therapeutic range, which may lead to neurological toxicity [10]. Previous studies have suggested that the neurotoxic effects of lithium are associated with NMS [10]. Han et al reported two patients with RESLES with lithium-associated neurotoxicity who were diagnosed with schizophrenia or BD [11].…”

Section: Discussionmentioning

confidence: 99%

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Reversible splenial lesion syndrome induced by paracetamol and lithium: two case reports

Zhou,

Zhang,

Zhou

et al. 2024

Preprint

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Background: Reversible splenial lesion syndrome (RESLES) is a rare neurological syndrome characterized by a reversible lesion in the splenium of the corpus callosum (SCC). Various etiologies, such as infection, high-altitude cerebral edema, seizures, antiepileptic drug (AED) withdrawal, and metabolic abnormalities, are involved in the development of RESLES. However, few studies have reported the occurrence of this disorder associated with medications, particularly paracetamol, which has not yet been documented. Case presentation: A 50-year-old man with neuropsychiatric symptoms who was receiving increased doses of paracetamol was referred to our hospital. The patient fully recovered 8 days after treatment. The second case involved a 35-year-old female who received 1500 mg/day lithium and 500 mg/day quetiapine for bipolar disorder (BD). She experienced generalized tremor, rigidity, dysarthria, high fever, hypertension, tachycardia, and tachypnea. Symptoms and brain lesions fully resolved two weeks after discontinuation of lithium. Brain magnetic resonance imaging (MRI) in both patients typically demonstrated a reversible lesion with transiently reduced diffusion in the SCC. Conclusion: RESLES is a rare finding that is usually incidentally detected. Therefore, MRI should be performed to evaluate SCC in patients taking excessive medication who present with neuropsychiatric symptoms.

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Reversible Splenial Lesion Related to Acute Lithium Intoxication in a Bipolar Patient

Cited by 6 publications

References 11 publications

Lithium induced reversible Splenial lesion in neuroleptic malignant syndrome like symptoms: two case reports

Lithium induced reversible Splenial lesion in neuroleptic malignant syndrome like symptoms: two case reports

Reversible splenial lesion syndrome induced by paracetamol and lithium: two case reports

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