Discussion. Serotonin Syndrome. Serotonin. 5-hydroxytryptamine or 5-HT Discovered in 1948 Major role in multiple clinical states. Lack of serotonin linked to: Aggression, pain, sleep, appetite Anxiety, depression Migraine, emesis. Serotonin Metabolism. Dietary tryptophan
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- Series of reactions to convert to 5-HT
Serotonin Reuptake Inhibitors
Monoamine oxidase inhibitors
The neuromuscular features of CLONUS and HYPERREFLEXIA are highly diagnostic for SS, and their occurrence in setting of serotonergic drug use establishes the diagnosis.
(Boyer and Shannon, 2005)
Hunter Serotonin Toxicity Criteria more specific
Severe Serotonin Toxicity/ Serotonin Crisis
NMS is an idiopathic reaction to dopamine antagonists, such as atypical antipsychotics (clozapine, risperidone, olanzapine), anti-emetics (metoclopramide, promethazine), TCAs.
Defined by a SLOWER ONSET (days), bradykinesia, “lead-pipe” muscular rigidity, hyperthermia, fluctuating LOC and autonomic instability.
(Servilloet al., 2007)
1. Autoregulatory Failure with Hyperperfusion
2. Endothelial Dysfunction with Hypoperfusion
Both result in cerebral blood perfusion abnormalities causing BBB dysfunction & cerebral vasogenic oedema
(Hinchey et al., 1996)
PRES mainly involves the parietal-occipital lobes; however, cerebellar hemispheres, basal ganglia, frontal lobes, and brainstem are also often involved (Servilloet al., 2007).
CT FLAIR DWI
and to bring the BP down to 160/100 mmHg within the 1st 6 hours.
Lower diastolic BP to 100-105 mmHg within 2-6 hrs.
(Legrielet al., 2012)