Creutzfeldt-Jakob-like EEG Changes in a Case of Fatal Lithium Toxicity

摘要

We present a case of fatal lithium toxicity with EEG changes suggesting Creutzfeldt-Jakob disease. A 52-year-old woman was admitted with declined consciousness, fever, and generalized seizures. She had bipolar affective disorder and was on lithium and chlorpromazine treatment for about three decades. Her family described that she had systemic symptoms of lithium toxicity such as anorexia, nausea, vomiting, diarrhea, and insomnia for one month. Neurological examination disclosed declined consciousness, generalized hypotonia and hyporeflexia. Laboratory examinations revealed leukocytosis, hyperglycemia, and renal and thyroid dysfunction. Cerebrospinal fluid examination and cranial computerized tomography were unremarkable. The EEG demonstrated widespread slow wave activity and runs of periodic sharp waves, some with a triphasic pattern. Blood level of lithium was 1,88 mEq/L. In spite of repeated hemodialyses, she became comatose and died one week after admission. This case represents an uncommon presentation of lithium toxicity with Creutzfeldt-Jakob like EEG changes and fatal outcome inspite of normalization of lithium levels.