Additional Professor, Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, KA, India.
Associate Professor, Department of Neuroimaging and Interventional Radiology (NIIR), National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, KA, India.
Trop Doct. 2024 Jan;54(1):53-55. doi: 10.1177/00494755231209393. Epub 2023 Oct 30.
Acute toxic leukoencephalopathy and serotonin syndrome are rare neurological complications associated with various drugs and toxins, some of which overlap. However, the co-occurrence of these conditions is poorly documented. We present the case of a 14-year-old boy who suddenly developed altered consciousness and autonomic dysfunction after consuming excessive quantities of cough remedies containing dextromethorphan, chlorphenamine, dichlorobenzyl alcohol, and amylmetacreson. Magnetic resonance imaging of the brain revealed distinct white matter lesions. With supportive care, the patient rapidly improved, and the magnetic resonance imaging abnormalities disappeared. The swift resolution, typical magnetic resonance imaging findings, and a history of exposure to drugs affecting the central nervous system's serotonergic system suggested concurrent acute toxic leukoencephalopathy and serotonin syndrome. The components of cough medications can be hazardous in overdose due to their potential to enhance serotonin toxicity and cause direct or indirect central nervous system white matter damage. Early recognition and appropriate treatment are essential for recovery.
急性中毒性脑白质病和血清素综合征是与各种药物和毒素相关的罕见神经并发症，其中一些存在重叠。然而，这些病症同时发生的情况记录甚少。我们报告了一例 14 岁男孩的病例，他在过量服用含有右美沙芬、氯苯那敏、二氯苯甲醇和醋氨己酸的咳嗽药后突然出现意识改变和自主神经功能障碍。脑部磁共振成像显示明显的白质病变。经过支持性治疗，患者迅速好转，磁共振成像异常消失。快速缓解、典型的磁共振成像表现以及接触影响中枢神经系统 5-羟色胺能系统的药物的病史提示同时发生急性中毒性脑白质病和血清素综合征。咳嗽药物的成分因可能增强 5-羟色胺毒性并导致直接或间接的中枢神经系统白质损伤，在过量服用时可能具有危害性。早期识别和适当的治疗对于恢复至关重要。
