1/44. Quetiapine as an alternative to clozapine in the treatment of dopamimetic psychosis in patients with Parkinson's disease.There are many difficulties associated with the late stages of Parkinson's disease (PD), but psychosis and agitation may be the most disturbing for both patients and care givers, and often precipitate the pivotal decision for long-term nursing home placement. While the addition of antipsychotic drugs or the withdrawal of antiparkinsonian drugs may improve the behavioral problem, these strategies usually worsen the motor difficulties. clozapine has been studied in PD for over a decade, and while it appears to be effective, there are safety and tolerability concerns associated with it. In addition, in new jersey, medicaid no longer pays for the home blood draws that are required for home-bound patients. This led to a situation in which we had patients who needed to stop clozapine and begin an alternative therapy. Because quetiapine seems particularly well suited to patients with PD based on in vitro and in vivo studies we have begun to try this medication in PD patients who need to stop clozapine. This article reports three case histories of patients with PD, confusion and dopamimetic psychosis who had been previously managed with clozapine and who were successfully switched to quetiapine. At doses from 12.5 to 150 mg/day quetiapine was well tolerated, resulting in behavioral improvement and no real increase in parkinsonism. These case histories raise the possibility that quetiapine may represent a viable alternative to clozapine in PD patients with dopamimetic psychosis and behavioral disturbances.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
2/44. Acute mental status changes and hyperchloremic metabolic acidosis with long-term topiramate therapy.Mental status changes and metabolic acidosis may occur with topiramate therapy. These adverse events were reported during dosage titration and with high dosages of the drug. A 20-year-old man receiving topiramate, valproic acid, and phenytoin experienced acute-onset mental status changes with hyperchloremic metabolic acidosis. He had been receiving a modest dose of topiramate for 9 months. He was weaned off topiramate over 5 days, and his mental status returned to baseline within 48 hours of discontinuing the agent. This case illustrates the need for close evaluation of patients who experience acute-onset mental status changes during topiramate therapy.- - - - - - - - - - ranking = 0.5keywords = drug (Clic here for more details about this article) |
3/44. fluorouracil-induced neurotoxicity.OBJECTIVE: To report a case of acute neurologic adverse effects related to fluorouracil administration and to review the neurotoxicity of this agent. CASE SUMMARY: A 73-year-old white man with a history of esophageal carcinoma was treated with fluorouracil 1,500 mg iv daily for four days. After completing treatment, he presented with sudden onset of confusion, cognitive disturbances, a cerebellar syndrome, and repeated seizures. A magnetic resonance image of the brain showed no structural abnormalities, and cerebrospinal fluid examination was normal; none of the other laboratory tests provided an explanation for his symptoms. The patient was treated with anticonvulsants, and the cognitive changes resolved in 72 hours. The cerebellar signs, however, did not resolve completely and persisted when the patient was examined two weeks after discharge. DISCUSSION: fluorouracil can cause both acute and delayed neurotoxicity. Acute neurotoxicity manifests as encephalopathy or as cerebellar syndrome; seizures, as seen in our patient, have rarely been reported. Acute neurotoxicity due to fluorouracil is dose related and generally self-limiting. Various mechanisms for such toxicity have been postulated, and treatment with thiamine has been recommended. Delayed neurotoxicity has been reported when fluorouracil was given in combination with levamisole; this form of subacute multifocal leukoencephalopathy is immune mediated and responds to treatment with corticosteroids. CONCLUSIONS: Clinicians should be aware of the adverse neurologic effects of fluorouracil and should include them in the differential diagnosis when patients receiving the drug present with neurologic problems.- - - - - - - - - - ranking = 0.5keywords = drug (Clic here for more details about this article) |
4/44. Psychotic symptoms and confusion associated with intravenous ganciclovir in a heart transplant recipient.A 65-year-old man underwent orthotopic cardiac transplantation and was prophylactically treated for cytomegalovirus infection with intravenous ganciclovir. He received standard dosages and had normal renal function. After 6 days of therapy he experienced psychotic symptoms with hallucinations, confusion, and disorientation. His altered mental status resolved after the drug had been discontinued for 5 days. ganciclovir was suspected as a cause of the symptoms. Alternative etiologies of were explored and excluded.- - - - - - - - - - ranking = 0.5keywords = drug (Clic here for more details about this article) |
5/44. Acute encephalopathy associated with metronidazole therapy.A forty-eight year-old male with amoebic liver abscess became encephalopathic 3 days following oral metronidazole. Withdrawal of the drug led to prompt resolution of all encephalopathic symptoms.- - - - - - - - - - ranking = 0.5keywords = drug (Clic here for more details about this article) |
6/44. Ingestion of antacid tablets (Rennie) and acute confusion.The authors describe a case of milk-alkali syndrome in a man who consumed antacid tablets (Rennie) for chronic epigastric pain. Simultaneous occurrence of hypercalcemia, metabolic alkalosis, and renal insufficiency, in conjunction with the appropriate history of ingestion of calcium carbonate-containing antacids, was suggestive of the syndrome. The syndrome became uncommon with the advent of modern ulcer therapy, but currently is increasing in frequency with the calcium supplementation drugs taken to prevent osteoporosis. This syndrome may produce life-threatening hypercalcemia.- - - - - - - - - - ranking = 0.5keywords = drug (Clic here for more details about this article) |
7/44. Nonconvulsive status epilepticus causing acute confusion.PRESENTATION: an elderly patient presented with acute confusion and was found to have nonconvulsive status epilepticus. She responded to treatment with anti-epileptic drugs. OUTCOME: this case illustrates an important, under-recognized and reversible cause of acute prolonged confusion.- - - - - - - - - - ranking = 0.5keywords = drug (Clic here for more details about this article) |
8/44. methadone, ciprofloxacin, and adverse drug reactions.ciprofloxacin, given to a patient successfully treated with methadone for more than 6 years, caused profound sedation, confusion, and respiratory depression. We suggest that this was caused by ciprofloxacin inhibition of CYP1A2 and CYP3A4 activity, two of the cytochrome p450 isozymes involved in the metabolism of methadone.- - - - - - - - - - ranking = 2keywords = drug (Clic here for more details about this article) |
9/44. confusion and dysphoria with low-dose topiramate in a patient with bipolar disorder.BACKGROUND: Topiramate, a newer antiepileptic agent, may benefit several neurological and psychiatric states, including bipolar disorder. CASE REPORT: A physically healthy, stockily built, 47-year-old, hypomanic Asian male with a >20-year history of uneventful use of psychotropic agents received topiramate in a dose that was stepped up to 100 mg/day across 10 days. He developed dysphoria, confusion, word-finding difficulties, and difficulties in maintaining a train of thought; the symptoms vanished within a week of drug discontinuation, and reappeared 1-2 days after rechallenge at a dose of 25 mg/day. CONCLUSION: It appears that, while confusion is usually a dose-dependent adverse effect of topiramate, certain patients may idiosyncratically develop this adverse effect at very low doses.- - - - - - - - - - ranking = 0.5keywords = drug (Clic here for more details about this article) |
10/44. magnetic resonance imaging detection of a lesion compatible with central pontine myelinolysis in a pregnant patient with recurrent vomiting and confusion.The authors report a patient who presented with unexplained confusion. She was 15 weeks pregnant and had been having recurrent vomiting for several weeks. This was felt to possibly represent hyperemesis gravidarum, but she had several other possible contributing factors. Her serum sodium was 146 mmol/L, and her potassium was 2.6 mmol/L. She was alert but had disorientation, visual hallucinations, memory impairment, and confabulation despite being a college graduate with no history of illicit drug use or excessive alcohol consumption. Her initial magnetic resonance imaging (MRI) brain scan was interpreted as being normal. However, her follow-up MRI brain scan revealed typical findings of central pontine myelinolysis, which correlated with hyperreflexia and positive Babinski reflexes. This patient illustrates the constellation of signs and symptoms that can be seen with a demyelinating lesion of the pons. In addition, our case illustrates how this MRI scan finding can be quite nonspecific but may help to explain the clinical findings.- - - - - - - - - - ranking = 0.5keywords = drug (Clic here for more details about this article) |
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