Serotonin syndrome in patients with peripheral neuropathy: a diagnostic challenge.
According to the Hunter Serotonin Toxicity Criteria, the presence of either clonus or hyperreflexia is a must for making a diagnosis of serotonin syndrome (SS). We report five patients with SS who had areflexia because of associated polyneuropathy. None of the patients fulfilled the Hunter criteria for SS. However, all five patients had features suggestive of neuromuscular hyperactivity, autonomic hyperactivity and altered mental status and fulfilled the Sternbach criteria for SS. All patients responded to cyproheptadine within 5 days to 2 weeks duration. These cases highlight the limitations of the Hunter criteria for SS in patients with associated polyneuropathy.
Department of Neurology, Smt. B. K. Shah Medical Institute & Research Centre, Piparia, Vadodara, India, 391760. Electronic address: drprakashs@yahoo.co.in.
Sanjay
S
Prakash
Department of Medicine, GMERS Medical College, Gotri, Baroda, Gujarat, India.
Falgun
F
Gosai
Department of Medicine, Smt. B. K. Shah Medical Institute & Research Centre, Piparia, Vadodara, India, 391760.
Jit
J
Brahmbhatt
Department of Medicine, Smt. B. K. Shah Medical Institute & Research Centre, Piparia, Vadodara, India, 391760.
Chintan
C
Shah
D000368:Aged; D003533:Cyproheptadine / Q000008:administration & dosage / Q000494:pharmacology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010523:Peripheral Nervous System Diseases / Q000175:diagnosis* / Q000188:drug therapy; D012702:Serotonin Antagonists / Q000008:administration & dosage / Q000494:pharmacology*; D020230:Serotonin Syndrome / Q000175:diagnosis* / Q000188:drug therapy; D016896:Treatment Outcome
D012702:Serotonin Antagonists; D003533:Cyproheptadine
Cyproheptadine; Peripheral neuropathy; Serotonergic agents; Serotonin syndrome