title: Atypical permanent neurological sequelae after an acute intoxication with lithium and aripiprazole.
abstract: The aim of the present case report was to describe atypical neurological sequelae after a lithium and aripiprazole co-intoxication in a suicide attempt.
  
  
  
  We report the case of a 31-year-old patient with bipolar disorder who developed, after lithium and aripiprazole massive ingestion, a severe pseudobulbar dysarthria and motor disorders suggestive of basal ganglia micro lesions. We review literature on neurological sequelae due to acute lithium intoxications.
  
  
  
  Acute lithium intoxication can cause permanent neurological sequelae, the most frequent clinical feature being a permanent cerebellar syndrome. Moreover, the widely-prescribed combination of lithium with antipsychotics increases the neurotoxicity in lithium intoxications. In this case, both atypical neurological syndrome and normal paraclinical investigations lead first to misdiagnose the lithium neurological damages.
  
  
  
  This case illustrates that acute lithium intoxications can result in serious and potentially permanent neurological deficits, which remain difficult to diagnose. Imaging abnormalities are not constant, and neurological presentation can be atypical.
authors.affiliation: Psychiatry department, University Hospital of Saint Etienne, Saint Etienne, France.
authors.forename: S
authors.initials: S
authors.lastname: Cervello
authors.affiliation: Psychiatry department, University Hospital of Saint Etienne, Saint Etienne, France; Timone Institute of Neuroscience, UMR 7289, CNRS and Aix-Marseille University, Marseille, France.
authors.forename: A
authors.initials: A
authors.lastname: Cancel
authors.affiliation: U1059 INSERM, Lyon University, Department of Radiology, University Hospital of Saint-Etienne, Saint-Etienne, France.
authors.forename: C
authors.initials: C
authors.lastname: Boutet
authors.affiliation: U1059 INSERM, Lyon University, Department of Radiology, University Hospital of Saint-Etienne, Saint-Etienne, France.
authors.forename: F
authors.initials: F
authors.lastname: Schneider
authors.affiliation: Reeducation Department, University Hospital of Saint Etienne, Saint Etienne, France.
authors.forename: P
authors.initials: P
authors.lastname: Giraux
authors.affiliation: Neurology Department, University Hospital of Saint Etienne, Saint Etienne, France.
authors.forename: B
authors.initials: B
authors.lastname: Laurent
authors.affiliation: Psychiatry department, University Hospital of Saint Etienne, Saint Etienne, France; TAPE, EA7423, Jean Monnet University, Saint Etienne, France.
authors.forename: E
authors.initials: E
authors.lastname: Fakra
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000506:poisoning*; D000068180:Aripiprazole / Q000506:poisoning*; D001714:Bipolar Disorder / Q000523:psychology; D006801:Humans; D018020:Lithium Compounds / Q000506:poisoning*; D008297:Male; D020828:Pseudobulbar Palsy / Q000139:chemically induced*; D011596:Psychomotor Disorders / Q000139:chemically induced*; D013406:Suicide, Attempted
chemical_list: D014150:Antipsychotic Agents; D018020:Lithium Compounds; D000068180:Aripiprazole