(#27) A Rare Case of Syndrome of Irreversible Lithium-Effectuated Neurotoxicity (SILENT) Presenting with Stroke-like Symptoms

Abstract: Lithium is a lifesaving medication and the gold standard for management of bipolar disorder. It has a narrow therapeutic index, making toxicity an important clinical concern. This case reports a 70-year-old female patient with bipolar disorder who presented to the emergency department with stroke-like symptoms. Imaging results were negative for large vessel occlusion or acute brain injury. Further investigation revealed a lithium level of 1.6 mmol/L, confirming lithium toxicity. Patient had previously been maintained on the same dose of lithium for over twelve years with regular monitoring, yet had never had a level above 0.8 prior to acute toxicity. Contributing factors included dehydration, a history of type 2 diabetes, and the development of an acute kidney injury which likely impaired the excretion of lithium. Even with discontinuation, she continued to have symptoms of apathy and ataxia consistent with Syndrome of Irreversible Lithium-Effectuated Neurotoxicity (SILENT). This case underscores the importance of considering lithium toxicity in patients presenting with stroke-like symptoms, particularly those currently taking lithium and with predisposing factors such as renal impairment, diabetes, and advanced age. Prompt recognition and appropriate management of lithium toxicity can prevent potentially severe complications.Short Description: This case reports a patient with bipolar disorder that developed stroke-like symptoms, but was found to have lithium toxicity. Despite regular monitoring of lithium levels, factors such as dehydration, type 2 diabetes, and acute kidney injury contributed to toxicity. Discontinuing lithium did not resolve symptoms, which were consistent with Syndrome of Irreversible Lithium-Effectuated Neurotoxicity (SILENT). This case highlights the need to consider lithium toxicity in patients with stroke-like symptoms, particularly those with predisposing factors.Name of Sponsoring Organization(s): Hope Health