CHRONIC LITHIUM NEUROTOXICITY PRESENTING AS PARKINSONS-DISEASE

A 71 year old man who had been on lithium for 9 years for mania presen ted with an encephalopathic illness which was almost certainly due to lithium intoxication. Having recovered from this acute episode (althou gh he was left with some sequelae) he was recommenced on lithium for h is manic symptoms with a careful control of his blood levels. After re maining fairly stable for 8 years he presented with features suggestiv e of Parkinsonism and was admitted to hospital for investigation. Ther e was no history of taking additional medication such as antidepressan ts or antipsychotics. He died in hospital and a post-mortem examinatio n confirmed the cause of death as acute myocardial infarction. However histological examination of the brain revealed neurological sequelae of chronic lithium intoxication. There was no evidence of degenerative condition such as Parkinsonism or Alzheimer's disease.