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Subacute phenytoin intoxication syndrome.

R S Tindall, J Willerson

Archives of Internal Medicine

|July 1, 1978

Summary

Subacute phenytoin intoxication can occur in cardiac patients receiving the drug for arrhythmia control. This syndrome, marked by dementia and neurological issues, improves with drug withdrawal, highlighting the need for monitoring.

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Area of Science:

Neurology
Cardiology
Pharmacology

Background:

Phenytoin sodium is utilized for cardiac arrhythmia suppression in some non-epileptic patients.
Subacute intoxication with phenytoin can manifest in these individuals.
Recognizing this toxicity is crucial for accurate diagnosis and management.

Observation:

A specific syndrome was observed, characterized by dementia, cerebellar dysfunction, and peripheral neuropathy.
These neurological symptoms developed subacutely in patients on phenytoin therapy.
The presented case highlights a distinct clinical presentation of phenytoin toxicity.

Findings:

Phenytoin sodium intoxication can present with a constellation of neurological deficits.
The syndrome includes cognitive impairment (dementia), motor coordination issues (cerebellar dysfunction), and sensory/motor disturbances (peripheral neuropathy).
Withdrawal of phenytoin led to a gradual but noticeable improvement in the observed symptoms.

Implications:

This phenytoin intoxication syndrome may be misdiagnosed as cerebrovascular disease.
Clinicians should consider phenytoin toxicity in cardiac patients presenting with unexplained neurological symptoms.
Regular monitoring of serum phenytoin levels is recommended for patients on this medication, especially those with cardiac conditions.

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