Reversible cerebral vasoconstriction syndrome associated with tetrodotoxin poisoning: A case report

Abstract

An 81‐year‐old woman with a history of hypertension and Alzheimer's disease presented to the emergency department because of impaired consciousness. Physical examination revealed acute progressive generalized flaccid paralysis, hypertension, respiratory failure, and pupillary dilation. Although the patient did not complain of headache, head magnetic resonance angiography and magnetic resonance imaging showed multifocal segmental cerebral vasospasm and cerebral infarction in the left occipital lobe. Her family reported that although she did not have a license to cook pufferfish, she was in the habit of eating pufferfish. We subsequently detected tetrodotoxin in the patient's urine, and she was diagnosed with tetrodotoxin poisoning. As the symptoms of tetrodotoxin intoxication improved, head magnetic resonance angiography showed the disappearance of the multifocal segmental cerebral vasospasm. The patient's clinical course and imaging findings were consistent with reversible cerebral vasoconstriction syndrome (RCVS). Sympathetic overactivity after tetrodotoxin intoxication possibly caused the development of RCVS, and RCVS could not be ruled out even in the absence of the typical thunderclap headache. Magnetic resonance angiography is a useful modality when performing repeated examinations.

Acute Toxic Effects of Tetrodotoxin in Mice via Intramuscular Injection and Oral Gavage

“…As a low dosage of TTX can barely cross the blood–brain barrier [ 20 , 21 ], in a certain dose range, TTX predominantly affects the conduction of the peripheral nervous system and skeletal muscles via the blocking of Na v 1.4, Na v 1.6 and Na v 1.7 [ 19 ]; thus, the influence of TTX on the peripheral nervous system and skeletal muscles requires further investigation. Previous studies showed a trend for self-healing in TTX poisoning [ 22 , 23 , 24 , 25 ], but the process lacked detailed descriptions. Therefore, we established TTX poisoning models via i.m.…”