Abstract
Background Lithium is still the first-line agent for bipolar disorder. Despite common knowledge on monitoring lithium levels to prevent toxicity, it still occurs at varying degrees. Here we present a rare sequela of lithium toxicity, the Syndrome of Irreversible Lithium-Effectuated Neurotoxicity (SILENT). Case Presentation. A 56-year-old male war veteran who is fully functional despite being on chronic lithium therapy for Posttraumatic Stress Disorder (PTSD) and bipolar disorder presented at the emergency room with altered mental status and seizures associated with elevated lithium levels and renal insufficiency. Antiepileptic drugs were given for seizure control, and intermittent hemodialysis was done to clear the lithium. Despite clearance of the offending agent, the patient remained to have a generalized slowing on repeated EEG with only eye opening and nonpurposeful limb movements regained even after more than 2 months of lithium cessation. Conclusion SILENT has been coined after reports of persistent neurologic deficits were seen in patients who experienced lithium toxicity more than 2 months after cessation of lithium. Chronic lithium therapy predisposes to gradual accumulation of lithium in the brain. Demyelination is the typically reported feature of SILENT. It can also leave the patient in a persistent encephalopathic state. Chronic lithium toxicity from failure of monitoring puts patients on lithium therapy at risk.
Highlights
Lithium remains to be the first line in the treatment of bipolar disorder [1, 2]
The syndrome of irreversible lithium-effectuated neurotoxicity (SILENT) has been coined after case reports of persistent neurologic deficits after lithium toxicity despite normalization of lithium levels [5]. It is a rare sequela of lithium toxicity
We report a case of SILENT whose sequela is different from those in prior literature
Summary
Lithium is still the first-line agent for bipolar disorder. Despite common knowledge on monitoring lithium levels to prevent toxicity, it still occurs at varying degrees. A 56-year-old male war veteran who is fully functional despite being on chronic lithium therapy for Posttraumatic Stress Disorder (PTSD) and bipolar disorder presented at the emergency room with altered mental status and seizures associated with elevated lithium levels and renal insufficiency. Despite clearance of the offending agent, the patient remained to have a generalized slowing on repeated EEG with only eye opening and nonpurposeful limb movements regained even after more than 2 months of lithium cessation. SILENT has been coined after reports of persistent neurologic deficits were seen in patients who experienced lithium toxicity more than 2 months after cessation of lithium. Demyelination is the typically reported feature of SILENT It can leave the patient in a persistent encephalopathic state. Chronic lithium toxicity from failure of monitoring puts patients on lithium therapy at risk
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
