Amiodarone-Induced Ataxia: A Case Report of Severe Cerebellar Dysfunction and Review of Literature
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AMIODARONE-INDUCED ATAXIA: A CASE REPORT OF SEVERE CEREBELLAR DYSFUNCTION AND REVIEW OF LITERATURE S. SARRAZIN1, C. HEIN1, J. DELRIEU1, S. CRESTANI2, S. MENHOUR1, E. GILBERT-FONTAN1, G. ABELLAN VAN KAN1,3 1. Toulouse University Hospital. Geriatric Department, Toulouse, France; 2. Toulouse University Hospital. Otorhinolaryngology Department. Larrey Hospital, Toulouse, France; 3. University Paul Sabatier III. INSERM 1027, Toulouse, France. Corresponding author: Gabor Abellan Van Kan, Toulouse University Hospital. Geriatric Department. 224 Avenue de Casselardit. 31059 Toulouse, France, [email protected]
Abstract: Amiodarone therapy is widely prescribed in patients with atrial fibrillation. The higher prevalence of this arrhythmic heart disease, and the specific age-related issues of homeostasis in the elderly population, makes this group particularly exposed to its adverse effects. Among the many described side-effects, neurological impairments are the less documented and studied. Because amiodarone can be responsible for severe complications, as described in the case below, a close monitoring is necessary throughout its prescription. Awareness should be brought on the amiodarone-induced neurological side-effects as they could be overlooked. Key words: Amiodarone, ataxia, elderly, side-effects.
Introduction
damage are well-known, there is a need to increase awareness on neurological adverse events, infrequent, probably underreported, and many times overlooked. We present an interesting case of early severe amiodarone induced-cerebellar syndrome of an 85 year-old (yo) man.
Amiodarone, a class III antiarrhythmic agent, is one of the most prescribed antiarrhythmic drugs in patients with atrial fibrillation to maintain a sinus rhythm. Because of its numerous extracardiac side effects, it makes it a secondaryline treatment in the rhythm control strategy by the European Society of Cardiology (1). Still, it remains commonly used in the elderly population due to prevalence of atrial fibrillation. If side effects such as thyroid dysfunction, skin alteration or lung
Case report An 85-yo man, active and fully-autonomous, reported clinical picture of balance disorders, vertigo and dysarthria
Table 1 Radiological examination Radiological additional examinations
Results
Cerebral CT angiography
No arguments for recent ischemic or haemorrhagic stroke
Brain MRI (repeated 3 weeks later)
Numerous non-confluent periventricular and deep white matter hyperintensities suggesting vascular process (small vessel disease)
No occlusion of the supra-aortic vessels
Small right parieto-occipital ischemic sequelae
Age-related diffuse cortical and subcortical atrophy No meningeal lesion Medullary MRI Thoraco-abdominal and pelvis CT scan (repeated 1 month later) 18F-FDG PET scan
Upper gastrointestinal endoscopy
[1231]FP-CIT (DaTSCAN) scintigraphy
No evolving lesion
Degenerative disc disease
No abnormal intracanalar contrast-enhancement Unremarkable
No evolving lesion
Focal intense hypermetabolism in the second part of the d
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