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Posterior reversible encephalopathy syndrome in a patient with serotonin syndrome
  1. Sanjay Prakash1,
  2. Chaturbhuj Rathore2 and
  3. Rana Kaushikkumar1
  1. 1Neurology, Smt BK Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth, Waghodia, Gujarat, India
  2. 2Smt BK Shah Medical Institute and Research Centre, Vadodara, Gujarat, India
  1. Correspondence to Sanjay Prakash; drprakashs{at}yahoo.co.in

Abstract

Serotonin syndrome (SS) is a drug-induced clinical syndrome, characterised by a triad of cognitive impairment, autonomic hyperactivity and neuromuscular abnormalities. Hypertension, one of the common autonomic manifestations in SS, may lead to lead to several life-threatening conditions. Herein, we report a case of SS who had posterior reversible encephalopathy syndrome (PRES) because of high blood pressure.

A young male with a 5-month history of chronic tension-type headache and depression had been receiving amitriptyline and paroxetine. Increment of paroxetine led to the development of various new clinical features, fulfilling the Hunter criteria of SS. MRI brain revealed high-signal intensity lesions on T2 fluid-attenuated inversion recovery, and T2-weighted imaging in the posterior regions of the occipital, parietal, temporal and cerebellum lobes, suggestive of PRES. The patient responded to cyproheptadine. Autonomic hyperactivity, due to SS, is the most likely explanation of this association.

  • neuro ITU
  • drugs misuse (including addiction)
  • unwanted effects / adverse reactions

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Footnotes

  • Contributors SP, CR and RK were involved in the conception and design. SP and RK were involved in the acquisition of data. SP was involved in the manuscript preparation. CR and RK were involved in revising the draft for intellectual content. SP, CR and RK were involved in the final approval of the completed manuscript. SP was the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.