Article type: Case Report
Article title: Cerebellar atrophy with long-term phenytoin (pht) use: case report
Journal: Romanian Journal of Neurology
Year: 2017
Authors: Jamir Pitton Rissardo, Ana LetÃcia Fornari Caprara, Juliana Oliveira Freitas Silveira
E-mail: jamirrissardo@gmail.com
ABSTRACT
Cerebellar atrophy can be found with long-term phenytoin (PHT) use, acute phenytoin intoxication, normal aging brain, and alcohol abuse. Even a minor increase in the dose may lead to toxic concentrations, which may present by cerebellar symptoms, such as nystagmus, diplopia, dysarthria, and ataxia. The clinical manifestations are usually reversible with reduction or withdrawal of the drug, but occasionally may be persistent. We report a case of a 41-year-old male who presented to our institution with clinical signs and symptoms of cerebellar dysfunction associated with progressive cerebellar atrophy after long-term phenytoin use. He had ataxic gait, preserved strength, commuting deep reflexes, dysmetria, dysdiadochocinesia, scanning speech, and somnolence. Cranial computed tomography revealed enlargement of interfollicular cerebrospinal fluid spaces in the cerebellum and also slight enlargement of the fourth ventricle, suggesting signs of cerebellar volumetric reduction. PHT was withdrawn. On his return, six months later, he presented a significant improvement in cerebellar clinical signs and symptoms; he had atypical gait, mild dysmetria, diadochokinesia, and normal speech. In conclusion, a thorough patient's history should be obtained and clinicians should be vigilant with patients on phenytoin treatment. Therefore, if the patient has cerebellar signs with a correspondent clinical history of phenytoin intoxication CT scan should be helpful as an initial cerebellar assessment.
Key-words: Phenytoin, ataxia, cerebellum, atrophy
Full text available at:
DOI
10.37897/RJN.2017.3.8
Citation
Rissardo JP, Caprara AL, Silveira JO. Cerebellar atrophy with long-term phenytoin (pht) use: case report. Rom J Neurol 2017;16:123-125. https://doi.org/10.37897/RJN.2017.3.8
Figure 1. CT axial. Non-contrast cranial computed tomography scan demonstrating enlargement of inter follicular cerebrospinal fluid spaces in cerebellum and a slight enlargement of the fourth ventricle, suggesting signs of cerebellar volumetric reduction.
Figure 2. CT sagittal. Non-contrast cranial computed tomography scan demonstrating enlargement of inter follicular cerebrospinal fluid spaces in cerebellum and a slight enlargement of the fourth ventricle, suggesting signs of cerebellar volumetric reduction.
Figure 3. CT axial. Non-contrast cranial computed tomography scan demonstrating enlargement of inter follicular cerebrospinal fluid spaces in cerebellum and a slight enlargement of the fourth ventricle, suggesting signs of cerebellar volumetric reduction.