title: Shaking head means "no".
abstract: A 45-year-old man was admitted to the emergency department because of twitching of the head. The patient took a tablet of sumatriptan every 3-4 h because of increasing head pain after a car accident. Owing to depression, the patient was on long-term treatment with venlafaxine. The patient presented as hypertensive, tachycardic, with dyskinesia and spontaneous myoclonic movements of the right sternocleidomastoid muscle. In a CT scan of the head and cervical spine any fractures, bleeding or damage of the vessels after the accident could be ruled out. After discontinuation of all serotonergic agents, administration of lorazepam symptoms resolved 24 h after the last intake of sumatriptan. Serotonin syndrome is a clinical diagnosis, which requires a high-index of diagnostic suspicion. Clinical features include a broad spectrum of symptoms ranging from mild to life-threatening manifestations. Management is based on removal of precipitating drugs and symptomatic care including benzodiazepines.
authors.affiliation: Department of General Internal Medicine, Inselspital, University Hospital Bern, Bern, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Weiler
authors.forename: Alexander
authors.initials: A
authors.lastname: Offinger
authors.forename: Aristomenis K
authors.initials: AK
authors.lastname: Exadaktylos
mesh_terms: D003511:Cyclohexanols / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009207:Myoclonus / Q000139:chemically induced* / Q000209:etiology; D009334:Neck Muscles; D058825:Serotonin 5-HT1 Receptor Agonists / Q000009:adverse effects*; D020230:Serotonin Syndrome / Q000139:chemically induced* / Q000150:complications; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects*; D018170:Sumatriptan / Q000009:adverse effects*; D000069470:Venlafaxine Hydrochloride
chemical_list: D003511:Cyclohexanols; D058825:Serotonin 5-HT1 Receptor Agonists; D017367:Selective Serotonin Reuptake Inhibitors; D018170:Sumatriptan; D000069470:Venlafaxine Hydrochloride
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