Cerebellar Damage in a Patient on Lithium Developing Enteric Fever : a Case Report

The effects of lithium on the CNS range from commonly observed mild effects to life threatening, irreversible brain damage in rare instances of severe toxicity (Moore 1972, Hartitzach et al 1972, Reisberg & Gershon 1979, Kadgoanker et al 1981). Some of the common side effects include mild cognitive impairment, muscular weakness, tremors and EEG changes. Neurotoxicity usually presents with clouding of consciousness, abnormal movements, seizures and neurological deficits. According to Schou et al (1968) patients with lithium intoxication either die or recover completely with no lasting neurological sequelae. However, permanent cerebellar damage due to lithium toxicity manifesting as ataxia, tremors and dysarthria has been reported only recently (Sellers et al 1982, Hartitzsch 1972). Mostly, this neurotoxicity is associated with high serum lithium levels but it can occur even at low levels.