Isoniazid cerebellitis in a peritoneal dialysis patient

Chaitanya, V; Sangeetha, B; Reddy, Munish; Kumar, Avnish; Ram, R; Sivakumar, V

doi:10.1111/nep.12592

Cited by 6 publications

(1 citation statement)

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“…Patients who are on dialysis are more sensitive to isoniazid neurotoxicity, due to pyridoxine deficiency and reduced clearance of isoniazid. Isoniazid neurotoxicity may be prevented by supplementing pyridoxine in patients on dialysis [ 4 , 5 ].…”

Section: Discussionmentioning

confidence: 99%

Acute cerebellitis in adults: a case report and review of the literature

et al. 2017

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BackgroundAcute cerebellitis is a rare disease with the majority of cases described in children. Little is known about the clinical characteristics and outcome in adults.Case presentationA 37-year-old Caucasian woman presented with headache, nausea, and photophobia, and was diagnosed as having a migraine attack. Two days later, she subsequently returned with aggravated headache, dysarthria and horizontal nystagmus. Magnetic resonance imaging (MRI) showed a swollen cerebellum and hydrocephalus and the patient was diagnosed with acute cerebellitis. Cerebrospinal fluid (CSF) examination showed an elevated leukocyte count and protein. Blood serology showed the presence of immunoglobulin M and immunoglobulin G for both Epstein–Barr virus and cytomegalovirus. The patient was treated with dexamethasone and discharged to a rehabilitation center, where she fully recovered. We searched the literature for adult cases of acute cerebellitis. Including our patient, we identified 35 patients with a median age of 36 years. The etiology was unknown in 34% of cases. The most common clinical presentation consisted of headache, nausea/vomiting and ataxia. Six patients presented with only headache and nausea and subsequently returned with cerebellar signs. In 9 cases, the cerebellitis was complicated by hydrocephalus. Half of the patients ended up with neurological sequelae, while follow-up MRI was abnormal in 71%.ConclusionAcute cerebellitis in adults is a rare disorder which mainly presents with headache, nausea/vomiting and ataxia. To diagnose cerebellitis, imaging of the brain (preferably MRI) is required and CSF examination may be necessary to narrow the differential diagnosis. The treatment depends on the widely diverse etiology, and treatment with steroids is recommended in the case of cerebellar oedema and hydrocephalus. Neurosurgical intervention may be necessary to prevent brain herniation.Electronic supplementary materialThe online version of this article (10.1186/s13104-017-2935-8) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Acute cerebellitis in adults: a case report and review of the literature

et al. 2017

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Extracorporeal treatments for isoniazid poisoning: Systematic review and recommendations from the EXTRIP workgroup

et al. 2021

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Isoniazid toxicity from self‐poisoning or dosing errors remains common in regions of the world where tuberculosis is prevalent. Although the treatment of isoniazid poisoning is centered on supportive care and pyridoxine administration, extracorporeal treatments (ECTRs), such as hemodialysis, have been advocated to enhance elimination of isoniazid. No systematic reviews or evidence‐based recommendations currently exist on the benefit of ECTRs for isoniazid poisoning. The Extracorporeal Treatments in Poisoning (EXTRIP) workgroup systematically collected and rated the available evidence on the effect of and indications for ECTRs in cases of isoniazid poisoning. We conducted a systematic review of the literature, screened studies, extracted data on study characteristics, outcomes, and measurement characteristics, summarized findings, and formulated recommendations following published EXTRIP methods. Forty‐three studies (two animal studies, 34 patient reports or patient series, and seven pharmacokinetic studies) met inclusion criteria. Toxicokinetic or pharmacokinetic analysis was available for 60 patients, most treated with hemodialysis (n = 38). The workgroup assessed isoniazid as “Moderately Dialyzable” by hemodialysis for patients with normal kidney function (quality of evidence = C) and “Dialyzable” by hemodialysis for patients with impaired kidney function (quality of evidence = A). Clinical data for ECTR in isoniazid poisoning were available for 40 patients. Mortality of the cohort was 12.5%. Historical controls who received modern standard care including appropriately dosed pyridoxine generally had excellent outcomes. No benefit could be extrapolated from ECTR, although there was evidence of added costs and harms related to the double lumen catheter insertion, the extracorporeal procedure itself, and the extracorporeal removal of pyridoxine. The EXTRIP workgroup suggests against performing ECTR in addition to standard care (weak recommendation, very low quality of evidence) in patients with isoniazid poisoning. If standard dose pyridoxine cannot be administered, we suggest performing ECTR only in patients with seizures refractory to GABAA receptor agonists (weak recommendation, very low quality of evidence).

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Revisiting the Clinical Phenomenology of “Cerebellar Tremor”: Beyond the Intention Tremor

Lenka

Louis

2018

Cerebellum

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Isoniazid cerebellitis in a peritoneal dialysis patient

Cited by 6 publications

References 2 publications

Acute cerebellitis in adults: a case report and review of the literature

Acute cerebellitis in adults: a case report and review of the literature

Extracorporeal treatments for isoniazid poisoning: Systematic review and recommendations from the EXTRIP workgroup

Revisiting the Clinical Phenomenology of “Cerebellar Tremor”: Beyond the Intention Tremor

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