1/4. Spasticity due to phenytoin toxicity.A young epileptic presented with spasticity as well as ataxia, diplopia and nystagmus; his serum phenytoin level was very high. All the abnormal signs disappeared after withdrawal of phenytoin. Spasticity, hyperreflexia, and clonus are features of phenytoin intoxication, present in this case, which are not commonly seen, and which have rarely been mentioned previously in the literature.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
2/4. Intrathecal baclofen overdose: report of 7 events in 5 patients and review of the literature.This study is intended to alert the clinician to the insidious symptoms of baclofen overdose, its prevention and treatment. In a group of 43 patients suffering from previously intractable spasticity and a total treatment time of 2,422 weeks, 7 events of intrathecal baclofen overdose happened in 5 patients. On two occasions, a bolus injection caused an overdose (dose 50 and 280 micrograms). The 5 events during continuous infusion intoxication only happened in high dosed patients. The overdose symptoms occurred in one patient when she was lying in supine position (800 micrograms/24 h), in another patient after repair of CSF leakage by an autologous epidural bloodpatch (1,920 micrograms/24 h) and in tolerant patients, once during maximal dose adjustments (2,400 micrograms/24 h) and twice ca. 6 hours following reinitiation of the intrathecal baclofen infusion after a "drug holiday" treatment (27 and 55 micrograms/h). We could not confirm the reported similarity of baclofen overdose with the anticholinergic syndrome. Especially, the bradycardia and hypotension are more in accord with the reported clinical picture of oral baclofen overdose. In the absence of a pure baclofen antagonist and the varying symptoms of intrathecal baclofen, intoxication make rational treatment difficult. We observed that the advised physostigmine therapy is not always effective and safe. The occasionally doubtful antidotal benefits of physostigmine must be weighted against major side-effects. The classical approach of decreasing the absorption of a drug by lowering baclofen levels in the CSF by lumbar puncture drainage was successful. This approach together with conservative symptomatic treatment in an intensive care environment is probably a better and safer alternative than physostigmine alone as an antidote.- - - - - - - - - - ranking = 2keywords = intoxication (Clic here for more details about this article) |
3/4. Neuropathy due to phytosol (agritox). Report of a case.A case of intoxication with Phytosol (an insecticide) in a 29-year-old man is described. Ingestion of Phytosol (suicide attempt) produced signs of cholinergic crisis followed, after 16 days, by features of peripheral neuropathy and later, with the regression of signs of polyneuropathy, gradually increasing spastic paralegia. Electrophysiological investigation of nerves which were clinically moderately involved demonstrated sparing of sensory fibers and damage to motor fibers. There was no change in maximal motor conduction velocity. histology of the clinically involved sural nerve revealed axonal changes together with demyelination, presumed to be secondary in type. This case shows that the susceptibility to delayed nervous system damage in man is greater than it might be expected from experimental studies and calls for caution in human exposure to these compounds.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
4/4. Chronic bromvalerylurea intoxication: dystonic posture and cerebellar ataxia due to nonsteroidal anti-inflammatory drug abuse.Nalon-Ace and other nonsteroidal anti-inflammatory drugs (NSAID) containing bromvalerylurea (BVU) are sold as over-the-counter (OTC) drugs and are obtainable without prescription in japan. A 32-year-old woman was diagnosed as having chronic BVU intoxication due to habitual use of Nalon-Ace. In addition to cerebellar ataxia and pyramidal signs well known in this condition, she showed an as yet non-described dystonic posture of the neck. Laboratory tests revealed an elevated concentration of serum organic bromide, iron deficiency anemia, and hyperchloremia. brain magnetic resonance imaging (MRI) revealed definite cerebellar atrophy. We should consider the possibility of chronic BVU intoxication in peculiar neurological cases like ours.- - - - - - - - - - ranking = 6keywords = intoxication (Clic here for more details about this article) |