New Onset Encephalopathy with Toxic Triphasic Waves

Abstract

New onset encephalopathy can have various causes like stroke, trauma, seizures, infections, demyelination, neoplasms, autoimmune, degenerative, and toxic and metabolic etiologies. Triphasic waves in electroencephalogram (EEG) is usually a clue to an ongoing metabolic process. We report a case of a 69-year-old female with bipolar disorder who presented with altered sensorium for the last 2 days. Her metabolic parameters, imaging, and cerebrospinal fluid findings were normal. Her EEG findings in the clinical setting provided a diagnostic clue to lithium toxicity, even though her serum lithium levels were normal. As her sensorium was progressively worsening, she was given a trial of hemodialysis with which she had significant improvement.