Long-term overdose of cold syrup induced hemichorea-hemiballismus

Li, Kuan‐Ying; Chien, Ching-Fang; Wu, Meng-Ni; Lai, Chiou-Lian; Liou, Li-Min

doi:10.1007/s10072-020-04475-6

Cited by 3 publications

(2 citation statements)

References 5 publications

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“…The most common cause of drug-induced asymmetric chorea is secondary to levodopa use in patients with idiopathic Parkinson’s disease who develop dyskinesia, however, this is outside of the scope of this review. Multiple other medications have been identified as causing an asymmetric or hemichorea including gabapentin [ 113 ], valproate [ 114 ], amphetamine [ 115 ], anti-histamine [ 116 117 ], selective serotonin reuptake inhibitors [ 118 ], neuroleptics [ 119 ] and z-drugs [ 120 ]. As previously mentioned, oral estrogen has been associated with drug-induced chorea as well, although this appears to be through a specific hormonal mechanism [ 105 106 107 108 109 ].…”

Section: Resultsmentioning

confidence: 99%

One Side of the Story; Clues to Etiology in Patients with Asymmetric Chorea

Cincotta¹,

Walker

2022

Tremor and Other Hyperkinetic Movements

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Background: Chorea can be due to a large number of etiologies. Unilateral chorea is classically related to a contralateral structural lesion, e.g. of the putamen or subthalamic nucleus, however, based upon personal impressions, we have observed that systemic disease, in particular metabolic or autoimmune conditions, can also lead to a unilateral or markedly asymmetric presentations. We sought to investigate this impression by reviewing the literature. Methods: A PubMed search was conducted using the terms asymmetric” AND “chorea” OR “hemichorea” OR “unilateral” AND “chorea” OR “monochorea” OR “right greater than left” AND “chorea” OR “left greater than right” AND “chorea” OR “right more than left” AND “chorea” OR “left more than right” AND “chorea” as well as “hemiballismus” NOT “stroke” NOT “infarct” NOT “dyskinesia. A total of 243 sources were felt to meet criteria and were reviewed. Results: The most common etiology of reported hemi- or asymmetric chorea was diabetic non-ketotic hyperglycemic hemichorea/hemiballismus. Other common diagnoses were Sydenham’s disease, antiphospholipid syndrome and drug-induced chorea. The vast majority of patients with hemi- or asymmetric chorea had acquired rather than genetic, degenerative or congenital causes. Conclusion: Despite the potential limitations of our literature review, the evidence presented here supports the observation that the vast majority of asymmetric or unilateral chorea presentations are due to acquired causes, and in this situation an exhaustive search for reversible etiology should be undertaken. However, presentation with symmetric, generalized chorea does not exclude reversible causes, and investigations should address these in addition to genetic and neurodegenerative etiologies.

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Section: Resultsmentioning

confidence: 99%

One Side of the Story; Clues to Etiology in Patients with Asymmetric Chorea

Cincotta¹,

Walker

2022

Tremor and Other Hyperkinetic Movements

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“…This sensitivity may also be potentiated by prior cocaine exposure. 102 Other agents linked to chorea include valproic acid, lamotrigine, and other antiseizure medications, [105][106][107][108][109][110][111] selective serotonin reuptake inhibitors, 112 fluoroquinolones, 113,114 cough syrup, 115 and "z-drugs" (nonbenzodiazepine hypnotics including zolpidem, zopiclone, and zaleplon). 116 In some of these situations, it has been surmised that there may have been an underlying vulnerability such as a structural lesion, or unrecognized genetic or metabolic factors.…”

Section: Toxic Causesmentioning

confidence: 99%

Diagnostic Uncertainties: Chorea

Cincotta

Walker

2023

Semin Neurol

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Chorea is a hyperkinetic movement disorder with a multitude of potential etiologies, both acquired and inherited. Although the differential diagnosis for new-onset chorea is extensive, there are often clues in the history, exam, and basic testing that can help to narrow the options. Evaluation for treatable or reversible causes should take priority, as rapid diagnosis can lead to more favorable outcomes. While Huntington's disease is most common genetic cause of chorea, multiple phenocopies also exist and should be considered if Huntington gene testing is negative. The decision of what additional genetic testing to pursue should be based on both clinical and epidemiological factors. The following review provides an overview of the many possible etiologies as well as a practical approach for a patient presenting with new-onset chorea.

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Caffeine/chlorphenamine/methylephedrine-hydrochloride/paracetamol overdose and misuse

2020

Reactions Weekly

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A 79-year-old woman developed hemichorea-hemiballismus following long-term overdose and misuse of caffeine/ chlorphenamine/methylephedrine hydrochloride/paracetamol.The woman, who had a history of hypertension, presented to the emergency department with an acute right-sided involuntary movements of 2 days. The involuntary movements continued throughout the day, but stopped while asleep. She could partially control them by her will, but could not be relieved by specific posture or touch. No limb numbness, fever, weakness, urinary and fecal incontinence or altered consciousness were observed. She had no preceding trauma or similar episode prior. Further, she was interviewed, during which she reported of chronic overdose (30mL) of over-the-counter cold syrup comprising of caffeine/ chlorphenamine/methylephedrine hydrochloride/paracetamol 1.8mg/0.124mg/0.486mg/14.94mg [acetaminophen, DLmethylephedrine hydrochloride, chlorpheniramine maleate and caffeine anhydrous] per mL of cough syrup due to long-term dizziness and that she had been taking an even higher dose during the previous week (recommended dose of the cold syrup: 12 mL/day). Neurological examination showed random, rapid, non-patterned, high-amplitude, flinging, flailing and violent involuntary movements of the right limbs, which was indicative of hemichorea-hemiballismus (HCHB). Rest of the physical and neurological examination was unremarkable. Laboratory tests (serum electrolyte level, urinalysis, complete blood count, liver function test, creatinine level, bilirubin level, blood glucose level, thyroid function and serum tests for heavy metal level), serum tests (for autoimmune disease, serum tumor marker levels) and cerebrospinal fluid examination were normal. MRI and CT scan of the brain were normal. Electroencephalography showed diffuse cortical dysfunction. Eleven days after the onset of involuntary movements, Tc-99methyl cysteinate dimer brain perfusion study (single-photon emission computed tomography [SPECT]) was performed showed relative hyperperfusion in the left basal ganglia. A diagnosis of cold syrup-induced HCHB was made based on the strong temporal relation and exclusion of any other cause of involuntary movements.The woman's cold syrup was discontinued, and she was treated with quetiapine. Her HCHB lasted for 2 weeks. Eight days after the initiation of quetiapine, her HCHB resolved. One month later, quetiapine was stopped. During 1 year follow-up, her HCHB did not reoccur [time to reaction onset not stated].

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Long-term overdose of cold syrup induced hemichorea-hemiballismus

Cited by 3 publications

References 5 publications

One Side of the Story; Clues to Etiology in Patients with Asymmetric Chorea

One Side of the Story; Clues to Etiology in Patients with Asymmetric Chorea

Diagnostic Uncertainties: Chorea

Caffeine/chlorphenamine/methylephedrine-hydrochloride/paracetamol overdose and misuse

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