Biomedical subjects
Publications and source records attributed to M R Samie.
We report 3 patients with post-traumatic tremor and describe the characteristics of the tremor and accompanying neurologic signs. Radiographic and pathologic examination indicated a contralateral midbrain localization of the lesion. The tremor responded to anticholinergic or dopaminergic therapy.
Cyproheptadine is an antihistamine with antiserotoninergic and anticholinergic properties. It is a relatively safe drug with many varied indications for usage, which rarely produces serious adverse neurologic sequelae. Reports of involuntary movement disorder secondary to cyproheptadine are rare. We present the case of a 17-year-old overdose victim which may be the first documented instance of cyproheptadine intoxication resulting in choreoathetosis. This hyperkinesia was most likely resultant from the anticholinergic properties of cyproheptadine. Although the choreoathetoid movement resolved spontaneously, the delirious state disappeared after administration of physostigmine.
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A prompt recognition of neuroleptic malignant-like syndrome is essential because of its high morbidity and mortality. A similar condition i described associated with metoclopramide, an agent with dopamine receptor-blocking properties. An increased index of suspicion for early diagnosis of this condition and adjustment of metoclopramide dosing in patients with renal failure are emphasized.
A case of severe life-threatening tardive dyskinesia resulting in esophageal and respiratory difficulties due to metoclopramide therapy is presented. A 66-year-old man with a primary diagnosis of clear cell carcinoma of the biliary duct was treated with metoclopramide for gastrointestinal symptoms related to his chemotherapy regimen. The patient initially presented with tremor and rigidity in the upper extremities. On antiparkinsonian therapy, symptoms progressed to hemiballism and involuntary movements of the face, mouth, and tongue, with respiratory and esophageal dyskinesia. Despite discontinuance of metoclopramide, severe tardive dyskinetic symptoms resulted in placement of a gastrostomy tube to maintain nutritional support. This case along with others in the literature should emphasize the need for continuous reevaluation of metoclopramide during long-term therapy, since serious side effects have been reported to occur.
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