[Drifting into silence]

A 63-year-old female patient presented with tremor, articulation difficulties, muscular weakness, and reduced alertness. Over the course of hospitalization, her neurological condition progressively worsened, with the development of myoclonus and ultimately a comatose state. Cerebral imaging, EEG, and cerebrospinal fluid analysis revealed no diagnostic abnormalities. Retrospective review showed an elevated lithium level seven weeks prior to presentation in the emergency department. Following hemodialysis, her neurological status gradually improved. This case highlights the clinical relevance of chronic lithium toxicity as a potentially reversible cause of severe encephalopathy.