PATHOLOGICAL ASSESSMENT OF CEREBELLAR ATROPHY FOLLOWING ACUTE LITHIUMINTOXICATION

Lithium carbonate is a widely used pharmacologic agent for acute bipol ar disorder, long term prophylaxis of mania in a bipolar patient, and prevention of ''manic overshoot'' with an antidepressant in acute depr ession in a bipolar patient. Although clinical neurological associatio ns with lithium overdose have been established, there has been a deart h of reports of pathologic changes related to lithium toxicity. We rep ort a case of a 52-year-old Black female with bipolar disorder who had been treated with lithium for over 5 years and who expired 24 days af ter presenting in a stuporous state with an elevated lithium level of 3.2 mEq/l. Postmortem neuropathologic examination revealed severe cere bellar atrophy of the internal granule and Purkinje cell layers with a ttendant Bergmann gliosis presumably resulting from chronic lithium us e and toxicity. There was also Alzheimer type II tell change in the th alamus and lentiform nuclei possibly due to terminal uremia, In summar y, this is a unique case which appears to illustrate cerebellar atropw hic changes related to lithium therapy and acute lithium intoxication.