Serotonin Syndrome

2016 ◽  
Author(s):  
Ravi Mirpuri ◽  
Danielle Perret Karimi
Keyword(s):  
Cardiac Arrhythmias ◽  
Serotonin Syndrome ◽  
Complex Disease ◽  
Altered Mental Status ◽  
Detailed Understanding ◽  
Neuromuscular Abnormalities ◽  
Life Threatening ◽  
The Central Nervous System ◽  
Autonomic Hyperactivity

Serotonin syndrome (SS) is a complication that occurs due to drug interactions that result in an increase in serotonin in the central nervous system. This syndrome is classically described as a triad of altered mental status, autonomic hyperactivity, and neuromuscular abnormalities that can be life threatening. As such, prompt detection is crucial so that treatment can be delivered to prevent long-term complications from hyperthermia, malignant hypertension, and/or cardiac arrhythmias. Determining the diagnosis can be difficult as several other conditions have similarities to SS; these include malignant hyperthermia, neuroleptic malignant syndrome, and anticholinergic toxicity. If appropriately managed, SS typically resolves within 24 hours once all serotoninergic medications are discontinued. If inappropriately prescribed, serotoninergic drugs such as antibiotics, analgesics, supplements, or antidepressants may all contribute toward inducing this preventable syndrome, if given in excess. This comprehensive review of SS provides the clinician with a detailed understanding of the pathogenesis, diagnosis, and treatment of this complex disease state

scholarly journals Serotonin Syndrome in the Setting of Lamotrigine, Aripiprazole, and Cocaine Use

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Anupam Kotwal ◽  
Sarah L. Cutrona
Keyword(s):  
Cocaine Abuse ◽  
Serotonin Syndrome ◽  
Pharmacodynamic Interactions ◽  
Serotonergic Activity ◽  
Threatening Condition ◽  
Neuromuscular Abnormalities ◽  
Life Threatening ◽  
The Central Nervous System ◽  
Autonomic Hyperactivity ◽  
Toxicity Criteria

Serotonin syndrome is a potentially life-threatening condition associated with increased serotonergic activity in the central nervous system. It is classically associated with the simultaneous administration of two serotonergic agents, but it can occur after initiation of a single serotonergic drug or increasing the dose of a serotonergic drug in individuals who are particularly sensitive to serotonin. We describe a case of serotonin syndrome that occurred after ingestion of higher than prescribed doses of lamotrigine and aripiprazole, in addition to cocaine abuse. The diagnosis was established based on Hunter toxicity criteria and severity was classified as mild. The features of this syndrome resolved shortly after discontinuation of the offending agents. Serotonin syndrome is characterized by mental status changes, autonomic hyperactivity, and neuromuscular abnormalities along a spectrum ranging from mild to severe. Serotonin syndrome in our patient was most likely caused by the pharmacokinetic and pharmacodynamic interactions between lamotrigine, aripiprazole, and cocaine leading to increased CNS serotonergic activity.

Neuroleptic Malignant Syndrome and Serotonin Syndrome

2019 ◽  
Author(s):  
Richard Sanders ◽  
Richard Krysiak
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Dopamine Agonists ◽  
Serotonin Syndrome ◽  
Clinical Symptoms ◽  
Altered Mental Status ◽  
Muscle Relaxants ◽  
Autonomic Instability ◽  
Life Threatening ◽  
Dopamine Circuits ◽  
Pharmacologic Treatments

Serotonin syndrome (SS) and neuroleptic malignant syndrome (NMS) are iatrogenic life-threatening conditions with similar clinical symptoms. Altered mental status, rigidity, and autonomic instability are common in both serotonin overload and toxic dopamine antagonism. It is paramount that providers understand the key differences between these two pathologies, as pharmacologic treatments can exacerbate the condition if SS is mistaken for NMS or vice versa. Hyperreflexia, clonus, diarrhea, and vomiting suggest the excessive activity of serotonin circuits in SS, whereas prominent rigidity and hyporeflexia suggest the underactivity of dopamine circuits in NMS. Supportive care and discontinuing the offending agent(s) are keys to treating both syndromes, but serotonin antagonists (eg, cyproheptadine) could be helpful in SS, whereas NMS may sometimes benefit from muscle relaxants (eg, dantrolene) and dopamine agonists (eg, bromocriptine). Following recovery, decisions about further use of an inciting agent (or similar agents) require reconsideration of risks, benefits, and alternatives, based on newly realized hazards. It is usually important to wait at least 2 weeks before rechallenge with any drugs resembling the inciting agents. This review contains 1 figure, 5 tables, and 29 references. Key Words: bromocriptine, cyproheptadine, dantrolene, Hunter criteria, neuroleptic malignant syndrome, parkinsonism, serotonin syndrome

Serotonin Syndrome

2019 ◽  
pp. 467-471
Author(s):  
Kevin T. Gobeske ◽  
Eelco F. M. Wijdicks
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Autonomic Nervous System ◽  
Serotonin Syndrome ◽  
Neuromuscular System ◽  
Autonomic Nervous ◽  
Life Threatening ◽  
The Central Nervous System ◽  
Serotonin Toxicity

Serotonin syndrome affects the central nervous system, the autonomic nervous system, and the neuromuscular system and can have acute and potentially life-threatening manifestations. By definition, serotonin syndrome is associated with changes in serotonin exposure and thus might be described more accurately as serotonergic excess or serotonin toxicity. The central nervous system effects of serotonin involve regulation of attention, arousal, mood, learning, appetite, and temperature.

scholarly journals Pitfalls in the Diagnosis and Management of Invasive Pneumococcal Meningoencephalitis – What We Can Learn From a Case

2017 ◽  
Vol 10 ◽  
pp. 117954761772550
Author(s):  
Pascale S Grzonka ◽  
Raoul Sutter
Keyword(s):  
Case Fatality Rate ◽  
Pneumococcal Meningitis ◽  
Case Fatality ◽  
Rapid Diagnosis ◽  
Common Type ◽  
Neurological Sequelae ◽  
Management Of Complications ◽  
Life Threatening ◽  
The Central Nervous System

Invasive pneumococcal meningitis is a life-threatening infectious disease affecting the central nervous system. It continues to be the most common type of community-acquired acute bacterial meningitides. Despite advances in neuro-critical care, the case fatality rate remains high. Rapid diagnosis and initiation of antibiotic therapy precludes mortality and long-term neurological sequelae in survivors. However, not all cases are easily recognised, and unanticipated complications may impede optimal course and outcome. Here, we describe a case of invasive pneumococcal meningoencephalitis in a 65-year-old man with an unusual initial presentation and pitfalls in the course of the disease. We highlight the importance of early diagnosis and treatment as well as recognition and management of complications.

scholarly journals Case-based review: pediatric medulloblastoma

2017 ◽  
Vol 4 (3) ◽  
pp. 138-150 ◽  
Author(s):  
Cassie N Kline ◽  
Roger J Packer ◽  
Eugene I Hwang ◽  
David R Raleigh ◽  
Steve Braunstein ◽  
...  
Keyword(s):  
Multimodal Approach ◽  
Ongoing Research ◽  
Group 4 ◽  
Pediatric Medulloblastoma ◽  
Life Threatening ◽  
The Central Nervous System ◽  
Group 3 ◽  
Multiagent Chemotherapy ◽  
Active Investigation

AbstractMedulloblastoma is the most common malignant brain tumor affecting children. These tumors are high grade with propensity to metastasize within the central nervous system and, less frequently, outside the neuraxis. Recent advancements in molecular subgrouping of medulloblastoma refine diagnosis and improve counseling in regards to overall prognosis. Both are predicated on the molecular drivers of each subgroup—WNT-activated, SHH-activated, group 3, and group 4. The traditional therapeutic mainstay for medulloblastoma includes a multimodal approach with surgery, radiation, and multiagent chemotherapy. As we discover more about the molecular basis of medulloblastoma, efforts to adjust treatment approaches based on molecular risk stratification are under active investigation. Certainly, the known neurological, developmental, endocrine, and psychosocial injury related to medulloblastoma and its associated therapies motivate ongoing research towards improving treatment for this life-threatening tumor while at the same time minimizing long-term side effects.

scholarly journals Serotonin syndrome due to an overdose of moclobemide?

CJEM ◽  
2002 ◽  
Vol 4 (02) ◽  
pp. 98-101 ◽  
Author(s):  
Andrew Ip ◽  
Tia Renouf
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Serotonin Syndrome ◽  
Monoamine Oxidase Inhibitor ◽  
Altered Mental Status ◽  
Oxidase Inhibitor ◽  
Important Condition ◽  
Autonomic Instability ◽  
Neuromuscular Abnormalities

ABSTRACTSerotonin syndrome, a triad of autonomic instability, altered mental status and neuromuscular abnormalities, is usually attributed to serotonergic overdoses. Moclobemide is a new selective monoamine oxidase inhibitor (MAOI) that generally causes mild, self-limited gastrointestinal and central nervous system effects after ingestion. We present a case of serotonin syndrome that occurred after moclobemide overdose, and discuss the recognition and treatment of this important condition. Serotonin syndrome may become increasingly common because of the liberal use of selective serotonin reuptake inhibitors, new MAOIs and other agents such as codeine and meperidine, which have the potential for harmful interaction.

scholarly journals Recent advances in the molecular epidemiology of clinical malaria

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 1159 ◽  
Author(s):  
Mario Recker ◽  
Peter C Bull ◽  
Caroline O Buckee
Keyword(s):  
Molecular Epidemiology ◽  
Complex Disease ◽  
Clinical Malaria ◽  
Population Diversity ◽  
Recent Advances ◽  
Intervention Measures ◽  
Specific Outcome ◽  
Life Threatening ◽  
Long Term Impact

Human malaria is a complex disease that can show a wide array of clinical outcomes, from asymptomatic carriage and chronic infection to acute disease presenting various life-threatening pathologies. The specific outcome of an infection is believed to be determined by a multifactorial interplay between the host and the parasite but with a general trend toward disease attenuation with increasing prior exposure. Therefore, the main burden of malaria in a population can be understood as a function of transmission intensity, which itself is intricately linked to the prevalence of infected hosts and mosquito vectors, the distribution of infection outcomes, and the parasite population diversity. Predicting the long-term impact of malaria intervention measures therefore requires an in-depth understanding of how the parasite causes disease, how this relates to previous exposures, and how different infection pathologies contribute to parasite transmission. Here, we provide a brief overview of recent advances in the molecular epidemiology of clinical malaria and how these might prove to be influential in our fight against this important disease.

scholarly journals Inflammation Unleashed in Viral-Induced Epileptogenesis

2021 ◽  
pp. 153575972110409
Author(s):  
Ana Beatriz DePaula-Silva ◽  
Laura A. Bell ◽  
Glenna J. Wallis ◽  
Karen S. Wilcox
Keyword(s):  
At Risk ◽  
Viral Infection ◽  
Ecological Changes ◽  
Therapeutic Development ◽  
Life Threatening ◽  
Encephalomyelitis Virus ◽  
The Central Nervous System ◽  
Human Viruses ◽  
The Relationship

Viral infection of the central nervous system increasingly places people at risk of developing life-threatening and treatment-resistant acute and chronic seizures (epilepsy). The emergence of new human viruses due to ongoing social, political, and ecological changes places people at risk more than ever before. The development of new preventative or curative strategies is critical to address this burden. However, our understanding of the complex relationship between viruses and the brain has been hindered by the lack of animal models that survive the initial infection and are amenable for long-term mechanistic, behavioral, and pharmacological studies in the process of viral-induced epileptogenesis. In this review, we focus on the Theiler’s murine encephalomyelitis virus (TMEV) mouse model of viral infection–induced epilepsy. The TMEV model has a number of important advantages to address the quintessential processes underlying the development of epilepsy following a viral infection, as well as fuel new therapeutic development. In this review, we highlight the contributions of the TMEV model to our current understanding of the relationship between viral infection, inflammation, and seizures.

scholarly journals Tramadol, Pharmacology, Side Effects, and Serotonin Syndrome: A Review

2015 ◽  
Vol 18;4 (4;18) ◽  
pp. 395-400
Author(s):  
Alan David Kaye
Keyword(s):  
Side Effects ◽  
Drug Interactions ◽  
Serotonin Syndrome ◽  
Potential Side Effect ◽  
Serotonergic Activity ◽  
Potential Abuse ◽  
Life Threatening ◽  
The Central Nervous System ◽  
Physician Reviews ◽  
Serotonergic Drugs

Background: Serotonin syndrome is a mild to potentially life-threatening syndrome associated with excessive serotonergic activity within the central nervous system. Serotonin syndrome is associated with medication use, drug interactions, and overdose. While serotonin syndrome is often associated with the use of selective serotonin inhibitors (SSRI), an increasing number of reports are being presented involving the use of tramadol. Methods: This review article contains an overview of serotonin syndrome while specifically looking at tramadol’s pharmacology and risk factors for serotonin syndrome. With tramadol’s increasing popularity, the goal of this article is to make physicians more alert and aware of this potential side effect associated with tramadol. Conclusions: In conclusion, with the increasing incidence of serotonin syndrome, prescribing physicians should be aware of and educate their patients on the potential side effects of tramadol. It is important that the prescribing physician reviews patient medications for concurrent serotonergic drugs and monitors for potential abuse. Key words: Tramadol, serotonin syndrome, drug interactions, analgesics

Primary Angiitis of the Central Nervous System - Clinical Approaches, Challenges and Controversies

2011 ◽  
Vol 6 (3) ◽  
pp. 181 ◽  
Author(s):  
Laura Gioia ◽  
Alexandre Y Poppe ◽  
Sylvain Lanthier ◽  
◽  
◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Immunosuppressive Agents ◽  
Clinical Manifestations ◽  
Brain Magnetic Resonance Imaging ◽  
Long Term Follow Up ◽  
Life Threatening ◽  
Primary Angiitis ◽  
The Central Nervous System

Primary angiitis of the central nervous system (PACNS) is a rare and life-threatening form of vasculitis confined to the CNS. A timely diagnosis is a real challenge because clinical manifestations of PACNS are diverse and nonspecific. Headaches, cerebrospinal fluid inflammation and abnormal brain magnetic resonance imaging are prevalent. When PACNS is suspected, a thorough investigation is mandatory to rule out several potential simulators and confirm the diagnosis. Treatment of PACNS is also a challenge involving competing forces, which include the threat of serious adverse effects of potent immunosuppressive agents and the risk of neurological deteriorations due to insufficient immunosuppressant therapy. Efforts are ongoing to delineate subtypes requiring different therapeutic approaches and having distinct prognoses. Despite recent progress, PACNS is still fatal in as much as one-sixth of cases. Long-term follow-up is mandatory in patients with PACNS.

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