Summary
A female patient, who died at the age of 61 and had suffered from several manic-depressive psychoses for more than 30 years, developed three phases of intoxication under lithium therapy. There was a 15-year history of electro- and Pentetrazol-induced convulsive therapy prior to lithium medication; neuroleptics were still administered during lithium therapy. The last lithium intoxication, 3 years prior to death was during a low-dosage therapy with normal lithium levels followed by severe lasting impairment: akinesia, rigidity, dysarthria, ataxia, and an organic alteration in character. For the first time, neuropathological findings could be established in such a case: extensive damage to granule and Purkinje cells in the cerebellum; gliosis in the dentate nucleus, the inferior olives, and the nucleus ruber; cytoplasmic inclusions in various nerve cells of the cranial nerve nuclei; cytoplasmic vacuoles, especially in the cells of the supra-optic nucleus.
Surprisingly little damage could be found in the substantia nigra and in the neostriatium. The clinical course as well as the pattern and intensity of the brain damage oppose an interpretation as a consequence of preceding convulsive shock therapy.
Zusammenfassung
Eine mit 61 Jahren verstorbene Patientin hatte während einer sich über dreißig Jahre hinziehenden manisch-depressiven Psychose dreimal unter der Lithium-Therapie eindeutige Intoxikationsphasen durchgemacht, nachdem eine Krampf-Therapie (Pentetrazol, Elektroschock, Insulin-Subcoma) Jahre zuvor durchgeführt worden war. Die letzte, drei Jahre vor dem Tod erfolgte Intoxikation bei niedriger Dosierung und normalem Lithium-Serumspiegel war von schweren Dauerschädigungen gefolgt (Akinese, Rigor, Dysarthrien, ataktische Störungen, Wesensänderung). Die neuropathologische Untersuchung — die Erstbeschreibung einer derartigen Schädigung — ergab ausgedehnte Schädigungen der Kleinhirnkörnerschicht und der Purkinjezellen, eine Gliose im Dentatum, den unteren Oliven und dem Nucleus ruber, Cytoplasmaeinschlüsse in verschiedene Nervenzellen der Hirnnervenkerngebiete und intracytoplasmatische Vacuolen, vor allem in Nervenzellen des Nucleus supraopticus. Überraschenderweise ergaben sich nur geringgradige pathologische Veränderungen in der Substantia nigra und im Neostriatum. Klinischer Verlauf sowie Verteilungsmuster und Intensität der Gewebsschäden sprechen gegen eine eventuelle Deutung als Folge einer vorausgegangenen Cardiazol- und Elektrokrampfbehandlung.
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Peiffer, J. Clinical and neuropathological aspects of long-term damage to the central nervous system after lithium medication. Arch Psychiatr Nervenkr 231, 41–60 (1981). https://doi.org/10.1007/BF00342829
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DOI: https://doi.org/10.1007/BF00342829
Key words
- Lithium therapy
- Manic depressive psychoses
- Long-term lithium damage
- Lithium intoxication
- Cerebellar degeneration