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[Reversible choreoathetosis associated with lithium intoxication].

Ken Wada1, Takanobu Sasaki, Yasushi Yoshimura

  • 1Department of Psychiatry, Hiroshima City Hospital.

Seishin Shinkeigaku Zasshi = Psychiatria Et Neurologia Japonica
|December 3, 2003
PubMed
Summary

Chorea-athetosis can occur with lithium toxicity. This case shows complete recovery after reducing lithium levels, highlighting the importance of prompt diagnosis and treatment for lithium intoxication.

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Area of Science:

  • Neuroscience
  • Psychiatry
  • Toxicology

Background:

  • Chorea-athetosis is a known complication of lithium intoxication, often associated with antipsychotic use.
  • Limited data exists on chorea-athetosis occurring solely due to lithium toxicity without concurrent antipsychotic treatment.

Observation:

  • A 65-year-old woman with bipolar II disorder presented with disorientation and choreoathetosis.
  • Her serum lithium level was markedly elevated at 3.52 mEq/L, indicating lithium intoxication.
  • EEG revealed bilateral symmetrical slow-wave activity, and she exhibited choreoathetosis in her face and extremities.

Findings:

  • The patient's choreoathetosis and consciousness disturbance resolved completely within 14 days of admission after management for lithium toxicity.
  • Treatment involved water loading and mannitol for forced diuresis to reduce serum lithium levels.

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  • EEG abnormalities normalized by day 23, and she was discharged with clinical remission, despite mild renal dysfunction.

    • Implications:

    • Chorea-athetosis can be a direct indicator of lithium intoxication, even without antipsychotic co-administration.
    • Prompt diagnosis and management, including serum lithium level monitoring and supportive care, are crucial for favorable outcomes.
    • Dopamine receptor hypersensitivity in nigrostriatal pathways may underlie choreoathetosis in susceptible individuals during lithium toxicity.