Central anticholinergic syndrome presenting as akinetic mutism

Area of Science:

• Neuroscience
• Clinical Toxicology

Background:

• Central anticholinergic syndrome (CAS) is a potentially serious condition resulting from excessive exposure to anticholinergic medications.
• Trihexyphenidyl hydrochloride is commonly used to treat Parkinsonism and extrapyramidal symptoms, but overdose can lead to severe toxicity.

Purpose of the Study:

• To report a unique case of central anticholinergic syndrome presenting as septal akinetic mutism with anisocoria.
• To explore the parallels between this human presentation and similar phenomena observed in animal models.
• To discuss the potential clinical applications and diagnostic considerations for this presentation.

Main Methods:

• Case report detailing clinical presentation, diagnostic findings, and management of a patient with trihexyphenidyl hydrochloride overdose.
• Literature review comparing the case to reported instances of anticholinergic toxicity in humans and animals.

Main Results:

• The patient exhibited septal akinetic mutism and unequally dilated pupils, consistent with central anticholinergic toxicity.
• Similar neurological and pupillary abnormalities have been documented in animal studies following anticholinergic administration.
• The findings suggest a potential shared pathophysiology across species for certain anticholinergic effects.

Conclusions:

• Central anticholinergic syndrome can manifest with distinct neurological signs, including akinetic mutism and anisocoria.
• Animal models may offer valuable insights into the mechanisms and clinical manifestations of drug-induced toxicities.
• Recognition of this presentation is crucial for timely diagnosis and management of anticholinergic overdose.