Mangano W E, Montine T J, Hulette C M
Duke University Medical Center, Department of Pathology, Durham, NC 27710, USA.
Clin Neuropathol. 1997 Jan-Feb;16(1):30-3.
Lithium carbonate is a widely used pharmacologic agent for acute bipolar disorder, long term prophylaxis of mania in a bipolar patient, and prevention of "manic overshoot" with an antidepressant in acute depression in a bipolar patient. Although clinical neurological associations with lithium overdose have been-established, there has been a dearth of reports of pathologic changes related to lithium toxicity. We report a case of a 52-year-old Black female with bipolar disorder who had been treated with lithium for over 5 years and who expired 24 days after presenting in a stuporous state with an elevated lithium level of 3.2 mEq/l. Postmortem neuropathologic examination revealed severe cerebellar atrophy of the internal granule and Purkinje cell layers with attendant Bergmann gliosis presumably resulting from chronic lithium use and toxicity. There was also Alzheimer type II cell change in the thalamus and lentiform nuclei possibly due to terminal uremia. In summary, this is a unique case which appears to illustrate cerebellar atrophic changes related to lithium therapy and acute lithium intoxication.
碳酸锂是一种广泛用于治疗急性双相情感障碍、双相情感障碍患者躁狂症的长期预防以及双相情感障碍患者急性抑郁发作时使用抗抑郁药预防“躁狂过度”的药物。尽管已经确定了临床神经系统与锂过量的关联，但关于锂毒性相关病理变化的报道却很少。我们报告了一例52岁的黑人女性双相情感障碍患者，她接受锂治疗超过5年，在出现昏迷状态且锂水平升高至3.2 mEq/l后24天死亡。尸检神经病理学检查显示，内颗粒层和浦肯野细胞层严重小脑萎缩，并伴有伯格曼胶质增生，推测这是长期使用锂及其毒性所致。丘脑和豆状核还出现了II型阿尔茨海默细胞改变，可能是由于终末期尿毒症。总之，这是一个独特的病例，似乎说明了与锂治疗和急性锂中毒相关的小脑萎缩变化。
