Venlafaxine-induced serotonin syndrome causing bilateral cerebral strokes: a case report
A 21-year-old Caucasian woman was admitted to our neurologic intermediate care unit after attempting suicide by ingesting an estimated 15 g venlafaxine (Trevilor retard®), adding up to a serum concentration of approximately 17,943 μg/l. Brain magnetic resonance imaging (MRI) revealed bilateral corti...
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Frontiers Media S.A.
2025-01-01
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| Series: | Frontiers in Stroke |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fstro.2024.1529674/full |
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| author | Nils Mein Khadija Mammadli Felix Luessi Timo Uphaus Timo Uphaus |
| author_facet | Nils Mein Khadija Mammadli Felix Luessi Timo Uphaus Timo Uphaus |
| author_sort | Nils Mein |
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| description | A 21-year-old Caucasian woman was admitted to our neurologic intermediate care unit after attempting suicide by ingesting an estimated 15 g venlafaxine (Trevilor retard®), adding up to a serum concentration of approximately 17,943 μg/l. Brain magnetic resonance imaging (MRI) revealed bilateral cortical restricted-diffusion patterns, indicating ischemic lesions. We report a case of venlafaxine-induced serotonin syndrome most likely cumulating in diffuse artery vasospasm due to an autonomic effect mediated by the serotonergic and adrenergic systems, causing myocardial and cerebral injuries. The serotonin syndrome was treated symptomatically by administering fluids and benzodiazepines and managing the hyperthermia using paracetamol; also, medication with venlafaxine was stopped, and the hypoglycemia was treated. After 6 days, our patient was discharged to the psychiatric facility with no remaining neurologic deficit. The case report provides evidence of ischemic stroke as a rare adverse event of venlafaxine intoxication. Furthermore, we aim to increase awareness of hypoglycemia and epileptic seizures as complications of venlafaxine intoxication. In addition, we demonstrate important pitfalls in the diagnostic procedure and propose a treatment regimen for the underlying serotonin syndrome. |
| format | Article |
| id | doaj-art-b7d3c732c84d43e4911691e461a9e3d6 |
| institution | Kabale University |
| issn | 2813-3056 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Stroke |
| spelling | doaj-art-b7d3c732c84d43e4911691e461a9e3d62025-01-13T06:11:06ZengFrontiers Media S.A.Frontiers in Stroke2813-30562025-01-01310.3389/fstro.2024.15296741529674Venlafaxine-induced serotonin syndrome causing bilateral cerebral strokes: a case reportNils Mein0Khadija Mammadli1Felix Luessi2Timo Uphaus3Timo Uphaus4Section of Translational Neuroimmunology, Department of Neurology, Jena University Hospital, Jena, GermanyDepartment of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, GermanyDepartment of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, GermanyDepartment of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, GermanyDepartment of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, GermanyA 21-year-old Caucasian woman was admitted to our neurologic intermediate care unit after attempting suicide by ingesting an estimated 15 g venlafaxine (Trevilor retard®), adding up to a serum concentration of approximately 17,943 μg/l. Brain magnetic resonance imaging (MRI) revealed bilateral cortical restricted-diffusion patterns, indicating ischemic lesions. We report a case of venlafaxine-induced serotonin syndrome most likely cumulating in diffuse artery vasospasm due to an autonomic effect mediated by the serotonergic and adrenergic systems, causing myocardial and cerebral injuries. The serotonin syndrome was treated symptomatically by administering fluids and benzodiazepines and managing the hyperthermia using paracetamol; also, medication with venlafaxine was stopped, and the hypoglycemia was treated. After 6 days, our patient was discharged to the psychiatric facility with no remaining neurologic deficit. The case report provides evidence of ischemic stroke as a rare adverse event of venlafaxine intoxication. Furthermore, we aim to increase awareness of hypoglycemia and epileptic seizures as complications of venlafaxine intoxication. In addition, we demonstrate important pitfalls in the diagnostic procedure and propose a treatment regimen for the underlying serotonin syndrome.https://www.frontiersin.org/articles/10.3389/fstro.2024.1529674/fullvenlafaxineserotonin syndromeischemic strokevasospasmcerebral injury |
| spellingShingle | Nils Mein Khadija Mammadli Felix Luessi Timo Uphaus Timo Uphaus Venlafaxine-induced serotonin syndrome causing bilateral cerebral strokes: a case report Frontiers in Stroke venlafaxine serotonin syndrome ischemic stroke vasospasm cerebral injury |
| title | Venlafaxine-induced serotonin syndrome causing bilateral cerebral strokes: a case report |
| title_full | Venlafaxine-induced serotonin syndrome causing bilateral cerebral strokes: a case report |
| title_fullStr | Venlafaxine-induced serotonin syndrome causing bilateral cerebral strokes: a case report |
| title_full_unstemmed | Venlafaxine-induced serotonin syndrome causing bilateral cerebral strokes: a case report |
| title_short | Venlafaxine-induced serotonin syndrome causing bilateral cerebral strokes: a case report |
| title_sort | venlafaxine induced serotonin syndrome causing bilateral cerebral strokes a case report |
| topic | venlafaxine serotonin syndrome ischemic stroke vasospasm cerebral injury |
| url | https://www.frontiersin.org/articles/10.3389/fstro.2024.1529674/full |
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