Phenytoin-Induced Ataxia and Diplopia in a Patient with Recent Subarachnoid Hemorrhage: A Case Report

Abstract

This case report presents a 25-year-old male with a complex medical history, including a recent subarachnoid hemorrhage (SAH) and a prescription for phenytoin. The patient exhibited neurological symptoms, such as ataxia, blurring of vision, and diplopia, prompting an intricate diagnostic evaluation. The medical history encompassed a prior road traffic accident resulting in a jaw injury, adding to the complexity of potential aetiologies, including cerebellar dysfunction, sequelae from the accidents, medication-related side effects (particularly phenytoin), or infectious/inflammatory causes. Given the reported symptoms, there arose a suspicion of phenytoin-induced ataxia and diplopia, common neurological side effects associated with this anticonvulsant. These symptoms, suggestive of cerebellar dysfunction, required a comprehensive examination, including neurological assessments and imaging studies, to elucidate the precise etiology. This case underscores the importance of meticulous medication review, particularly for drugs like phenytoin, and emphasizes the necessity of a multidisciplinary approach involving neurologists to navigate the complexities associated with neurological manifestations in the context of SAH and medication use. The findings contribute to understanding potential complications arising from anticonvulsant therapy in SAH patients and highlight the need for tailored diagnostic and management strategies in such intricate clinical scenarios.