CT findings following diphenylhydantoin intoxication

Area of Science:

• Neurology
• Radiology
• Toxicology

Background:

• Epilepsy management often involves anticonvulsant medications.
• Diphenylhydantoin (DPH) is a commonly used anticonvulsant.
• High-dose or prolonged DPH use can lead to toxicity.

Observation:

• Three female epileptic patients presented with varying degrees of irreversible ataxia.
• All patients had received toxic doses of diphenylhydantoin.
• Computed Tomography (CT) scans were performed to evaluate neurological changes.

Findings:

• CT imaging revealed significant cerebellar atrophy in all three patients.
• Specific findings included discernible sulci, a dilated fourth ventricle, basal cisterns, and enlarged subarachnoid spaces.
• These radiological findings are indicative of severe DPH toxicity affecting the cerebellum.

Implications:

• The observed CT findings are crucial for differentiating DPH-induced cerebellar atrophy from other conditions.
• This includes idiopathic ataxia, other toxic/systemic atrophies, and cerebellar dysontogenetic lesions.
• Recognizing these specific CT patterns aids in accurate diagnosis and management of anticonvulsant toxicity.