Reactions 1108 - 1 Jul 2006

SCitalopram

Delirium and extrapyramidal disorders in an elderlypatient: case report

A 77-year-old woman developed delirium andextrapyramidal disorders during treatment with citalopram fordepressive symptoms.

The woman was hospitalised for dehydration secondary toantibacterial-associated diarrhoea and had subtleextrapyramidal features including reduced mobility,psychomotor slowing, swallowing difficulty and increasedtone with cogwheeling in her left upper limb; she startedreceiving citalopram 10 mg/day. Over the next 4 days, hercondition deteriorated significantly, with markedly worsenedextrapyramidal signs and hypoactive delirium. She developedmarked bradykinesia and rigid limbs, associated with reducedself-care, monosyllabic speech, and decreased swallowingcoordination. She could no longer follow requests. Herdeterioration continued, with a reduced consciousness level,sustained ankle clonus with positive Babinski responses, andincreased rigidity with cogwheeling.

Citalopram was stopped 3 days after it was started, and thewoman received lorazepam for possible catatonia. Her liverfunction tests were mildly elevated, and her C-reactive proteinlevel was 10 mg/L. She was transferred to another hospital foradditional investigation and treatment. A brain MRI showedgeneralised brainstem, cortical and posterior fossa atrophy.Two attempts at lumbar puncture were unsuccessful. Over thenext 3 days, dystonic posturing of her upper limbs developed.Her rigidity in both upper limbs continued. Lorazepam wasstopped 5 days after it was started. Over the next 7 days, sheimproved and became more communicative and alert. Thetone in her upper limbs remained increased. She receivedlevodopa with no noticeable effect and levodopa was stopped.After 10 days, she was transferred back to the original hospital,where she improved over the next month and becameorientated and alert. She communicated freely and hadmobility using a low frame under supervision. The increasedtone in her upper limbs persisted, but improved.

Author comment: "This appears to be a case of aneurotoxic reaction with severe extrapyramidal features(Parkinsonism and dystonia) and delirium probably resultingfrom citalopram."Thwaites JH, et al. Neurotoxic reaction to citalopram. New Zealand MedicalJournal 119: 134-136, No. 1235, 2 Jun 2006 - New Zealand 801067681

1

Reactions 1 Jul 2006 No. 11080114-9954/10/1108-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved