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Neurology
Serotonin syndrome presenting as acute dizziness with supine hypertension and orthostatic hypotension
  1. Sanjay Prakash1,
  2. Ravisha Gupta2,
  3. Maitree M Raval2 and
  4. Charu Tibrewal3
  1. 1 Neurolgy, SBKS Medical Institute and Research Centre, Vadodara, India
  2. 2 Medicine, Smt BK Shah Medical Institute & Research Centre, Waghodia, Gujarat, India
  3. 3 Medicine, The Gujarat Research & Medical Institute, Ahmedabad, 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 combination of cognitive, neuromuscular and autonomic dysfunctions. The symptoms may include mild non-specific symptoms such as tremors and diarrhoea to coma and sudden death. Herein, we describe a case of SS in which acute dizziness was associated with supine hypertension and orthostatic hypotension. A man in his mid-30s had a 10-month history of anxiety, depression and chronic tension-type headache. He had been on amitriptyline (25 mg daily) and sertraline (50 mg daily). Increment of sertraline (75 mg daily) and amitriptyline (75 mg daily) and the addition of tramadol led to the development of acute severe dizziness. Physical examinations demonstrate supine hypertension and orthostatic hypotension. He also met the diagnostic criteria of SS. The administration of cyproheptadine provided a complete response to dizziness, supine hypertension, orthostatic hypotension and other clinical features of SS.

  • Neurology (drugs and medicines)
  • Drugs: psychiatry

https://doi.org/10.1136/bcr-2024-260229

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    Footnotes

    • X @drprakashs

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms and critical revision for important intellectual content: SP, RG, MMR and CT. The following authors gave final approval of the manuscript: SP, RG, MMR and CT.

    • 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.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

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