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Ataxia: a diagnostic perplexity and management dilemma
Vinod K Chaubey1, Lovely Chhabra, Aaysha Kapila
1Department of Internal Medicine, Saint Vincent Hospital, University of Massachusetss Medical School, Worcester, Massachusetts, USA.
BMJ Case Reports
|September 28, 2013
Summary
Amiodarone, a medication for atrial flutter, can cause cerebellar dysfunction and ataxia. Reducing the amiodarone dose improved the patient's mobility, highlighting drug-induced neurotoxicity.
Area of Science:
- Neurology
- Cardiology
- Pharmacology
Background:
- Atrial flutter is a common cardiac arrhythmia.
- Amiodarone is an effective antiarrhythmic drug but carries potential toxicities.
- Drug-induced neurotoxicity is a recognized adverse effect of various medications.
Observation:
- A 79-year-old woman developed progressive lower extremity weakness, unsteadiness, and ataxia.
- Her symptoms worsened with increased amiodarone dosage for refractory atrial flutter and ventricular tachycardia.
- Neurological examination revealed cerebellar dysfunction, while neuroimaging and extensive workup for other causes were negative.
Findings:
- Amiodarone-induced neurotoxicity was suspected due to the temporal relationship between increased dosage and symptom exacerbation.
- Reducing the amiodarone dose and introducing mexilitine led to significant improvement in ataxia and ambulation.
Implications:
- This case underscores the importance of considering amiodarone neurotoxicity in patients presenting with unexplained neurological symptoms.
- Careful dose titration and monitoring for neurological adverse effects are crucial when prescribing amiodarone.
- Prompt recognition and management of drug-induced neurotoxicity can lead to favorable patient outcomes.
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