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Serotonin syndrome in patients with peripheral neuropathy: a diagnostic challenge
Sanjay Prakash1, Falgun Gosai2, Jit Brahmbhatt3
1Department of Neurology, Smt. B. K. Shah Medical Institute & Research Centre, Piparia, Vadodara, India, 391760.
Abstract:
According to the Hunter Serotonin Toxicity Criteria, the presence of either clonus or hyperreflexia is a must for making a diagnosis of serotonin syndrome (SS). We report five patients with SS who had areflexia because of associated polyneuropathy. None of the patients fulfilled the Hunter criteria for SS. However, all five patients had features suggestive of neuromuscular hyperactivity, autonomic hyperactivity and altered mental status and fulfilled the Sternbach criteria for SS. All patients responded to cyproheptadine within 5 days to 2 weeks duration. These cases highlight the limitations of the Hunter criteria for SS in patients with associated polyneuropathy.
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