Persistent cerebellar ataxia with cerebellar cognitive affective syndrome due to acute phenytoin intoxication: A case report
- Author:
Meena Gupta
;
Yogesh Patidar
;
Geeta A. Khwaja
;
Debashish Chowdhury
;
Amit Batra
;
Abhijit Dasgupta
- Publication Type:Journal Article
- From:Neurology Asia
2013;18(1):107-111
- CountryMalaysia
- Language:English
-
Abstract:
Phenytoin is one of the commonly used antiepileptic drugs. The common dose dependent and reversible
neurological side effects of phenytoin are nystagmus, diplopia, dysarthria, ataxia, incoordination,
chorioathetosis, orofacial dyskinesias and drowsiness. Persistent cerebellar dysfunction with cerebellar
atrophy is a well known complication of long term phenytoin use. There are several mechanisms
proposed including hypoxia due to frequent seizures or toxic effects of phenytoin on cerebellar Purkinje
cells. However, irreversible cerebellar dysfunction following acute phenytoin intoxication is rare. We
report a 20 year old female who presented with nystagmus, dysarthria, limb and truncal ataxia with
orofacial dyskinesias and chorea. She also had cognitive and affective symptoms in the form of reduced
attention, slow responses, lalling speech, blunting of affect, inappropriate laughter, reduced self care
and executive dysfunction. The symptoms started 2 weeks following the initiation of phenytoin 300mg/
day, given prophylactically following left basal ganglia bleed. Her serum phenytoin was in toxic range,
hence phenytoin was stopped. Her PET scan revealed bilateral cerebellar hypometabolism. At 6 months
follow up, she had persistent ataxia with cognitive and affective dysfunction and follow up MRI
showed diffuse cerebellar atrophy. The clinical and radiological fi ndings suggest that acute phenytoin
intoxication is responsible for persistent ataxia and cerebellar cognitive affective syndrome.
- Full text:P020150706436239233019.pdf
