Figure Hunter Serotonin Toxicity Criteria Exposure to a serotonergic agent within the last 5 weeks [down arrow] Presence of any of the following symptoms: 1) Spontaneous clonus 2) Tremor and
hyperreflexia 3) Ocular clonus and either agitation or diaphoresis 4) Inducible clonus and either agitation or diaphoresis 5) Muscle rigidity, temperature >38[degrees]C (100.4[degrees]F), and either ocular clonus or inducible clonus [down arrow] Confirmation of serotonin syndrome Source: References 1,3 Antipsychotics, such as olanzapine and chlorpromazine, have been considered treatment alternatives due to their associated 5-HT2A receptor antagonism.
Urodynamic tests may report detrusor
hyperreflexia either sporadically or combined with impaired contractility, decreased bladder compliance or capacity, bladder hypersensitivity, hypoor acontractile bladder and increased postvoid residual urine concomitant to the detrusor
hyperreflexia (3, 5- 8, 10).
He had obvious cognitive impairment (MMSE and MoCA scores of 23 and 19, respectively) and decreased muscular strength (proximal muscle strength: Level III, distal muscle strength: Level IV) with
hyperreflexia and bilateral Babinski sign.
We present a 12-year-old male with classical clinical manifestations of Xeroderma Pigmentosum and severe neurologic abnormalities (intellectual disability, ataxia, altered speech, and
hyperreflexia), who carries a homozygous germline mutation in the XPC gene.
Over the days that followed, a gradual worsening occurred, with dysarthria, absent gag reflex and dysphagia, poor attention span, generalised
hyperreflexia, and vertical nystagmus.
Physical examination revealed negativism, intermittent rigidity, and generalised
hyperreflexia, but no clonus, autonomic dysfunction, diaphoresis, or fevers.
Repeat neurological exam elicited significant weakness and
hyperreflexia in the lower extremities bilaterally.
During the first several days of inpatient admission, she experienced progressive bilateral extremity clonus,
hyperreflexia, and urinary retention.
Pyramidal syndrome included hypertonia, clonus,
hyperreflexia, and increased archaic reflexes.
The son, a previously healthy boy aged 9 years, was found to have altered mental status, dysarthria, dystonia, rigidity, and
hyperreflexia, but was alert and answering questions.
Interestingly,
hyperreflexia was found in 7/16 patients (44%), and slowing of saccadic eye movements was seen in 2.