Weiler Stefan, Offinger Alexander, Exadaktylos Aristomenis K
Department of General Internal Medicine, Inselspital, University Hospital Bern, Bern, Switzerland.
BMJ Case Rep. 2013 Sep 10;2013:bcr2013200796. doi: 10.1136/bcr-2013-200796.
A 45-year-old man was admitted to the emergency department because of twitching of the head. The patient took a tablet of sumatriptan every 3-4 h because of increasing head pain after a car accident. Owing to depression, the patient was on long-term treatment with venlafaxine. The patient presented as hypertensive, tachycardic, with dyskinesia and spontaneous myoclonic movements of the right sternocleidomastoid muscle. In a CT scan of the head and cervical spine any fractures, bleeding or damage of the vessels after the accident could be ruled out. After discontinuation of all serotonergic agents, administration of lorazepam symptoms resolved 24 h after the last intake of sumatriptan. Serotonin syndrome is a clinical diagnosis, which requires a high-index of diagnostic suspicion. Clinical features include a broad spectrum of symptoms ranging from mild to life-threatening manifestations. Management is based on removal of precipitating drugs and symptomatic care including benzodiazepines.
一名45岁男性因头部抽搐被送往急诊科。该患者在车祸后因头痛加剧，每3 - 4小时服用一片舒马曲坦。由于患有抑郁症，该患者长期服用文拉法辛进行治疗。患者表现为高血压、心动过速，伴有运动障碍以及右侧胸锁乳突肌的自发性肌阵挛运动。在头部和颈椎的CT扫描中，可排除事故后出现的任何骨折、出血或血管损伤。停用所有血清素能药物后，在最后一次服用舒马曲坦24小时后，给予劳拉西泮治疗，症状得以缓解。血清素综合征是一种临床诊断，需要高度的诊断怀疑指数。临床特征包括从轻度到危及生命的广泛症状表现。治疗基于停用诱发药物以及包括苯二氮䓬类药物在内的对症治疗。
