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Chorea caused by lithium intoxication: a case report and literature review
1Albany Medical College, Department of Neurology, New York 12208, USA.
Insights
Lithium (Li) intoxication can cause reversible chorea, a movement disorder. This case highlights the importance of monitoring Li levels, especially when diuretics are used, to prevent neurological side effects.
Area of Science:
- Neurology
- Clinical Pharmacology
Background:
- Lithium (Li) is a mood stabilizer for bipolar disorder.
- Diuretic use can increase Li serum levels.
- Movement disorders are a known side effect of Li toxicity.
Observation:
- A patient developed acute, generalized chorea.
- Chorea onset was delayed after Li intoxication symptoms.
- The patient had other Li toxicity signs like ataxia and encephalopathy.
Findings:
- Chorea resolved as serum Li levels decreased.
- This is the 11th reported case of Li-induced chorea.
- It is the 6th case without concurrent neuroleptic therapy and the first with video confirmation.
Implications:
- Highlights the risk of Li-induced chorea, especially with diuretics.
- Emphasizes the need for careful Li level monitoring.
- Suggests further research into the mechanisms of Li neurotoxicity.
Abstract:
We report a patient who developed an acute, reversible, generalized choreiform disorder from lithium (Li) intoxication. This medication was prescribed for manic-depressive disorder, and serum levels became elevated after the addition of a diuretic for the treatment of hypertension. There were no other apparent causes for the movement disorder, and it was associated with other known features of Li intoxication, including ataxia and encephalopathy. There was a delay between the initial symptoms of Li intoxication and the onset of chorea. The chorea improved as serum Li levels diminished, with some lag time. This represents the eleventh case report of Li-induced chorea, but only the sixth in a patient without concomitant neuroleptic therapy, and the first presented with videotape confirmation. A review of these other cases is included, and possible mechanisms are discussed.