Lithium toxicity: neurological features

SILENT syndrome: definition

• This is a syndrome of irreversible lithium-effectuated neurotoxicity
• It is persistent cerebellar dysfunction after lithium poisoning
• It is possibly due to demyelination

SILENT syndrome: clinical features

Other neurological features

Differential diagnosis

Investigations

Treatment

References

1. 1Newman PK, Saunders M. Lithium neurotoxicity. Postgrad Med J 1979; 55:701-703.
2. Adityanjee, Munshi KR, Thampy A. The syndrome of irreversible lithium-effectuated neurotoxicity. Clin Neuropharmacol 2005; 28:38-49.
3. Farouji A, Battah A, Ahmad AS, Farouji I, Miller R. A unique case of the syndrome of irreversible lithium-effectuated neurotoxicity (SILENT) presenting with multiple neurological sequelae. Cureus 2023; 15:e38102.
4. Jørgensen JS, Landschoff Lassen L, Wegener M. Lithium-induced downbeat nystagmus and horizontal gaze palsy. Open Ophthalmol J 2016; 10:126-128.
5. Rust H, Lutz N, Honegger F, et al. Periodic alternating nystagmus in a patient on long-term lithium medication. J Neurol Sci 2016; 369:252-253.
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Related checklists

• Lithium toxicity: risk factors
• Lithium toxicity: systemic features
• Lithium toxicity: severity classification
• Lithium toxicity: management