Anticholinergic toxidrome due to thorn apple seed ingestion in an elderly couple
  • Pepijn van Gastel
    Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, Netherlands
  • Jildou N. Dijkstra
    Department of Neurology, Radboud University Medical Centre, Nijmegen, Netherlands
  • Mina A. Jacob
    Department of Neurology, Radboud University Medical Centre, Nijmegen, Netherlands
  • Jeroen A. Schouten
    Department of Intensive Care, Radboud University Medical Centre, Nijmegen, Netherlands
  • Bram Kok
    Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, Netherlands

Keywords

Anticholinergic toxidrome, physostigmine

Abstract

Introduction: Sudden onset of reduced consciousness, psychomotor agitation and mydriasis are all indicative of an anticholinergic toxidrome. It is important to note that numerous drugs, as well as certain herbs and plants, possess anticholinergic properties.
Case description: An 84-year-old female patient had sudden nocturnal onset of uncoordinated hand movements and altered mental status. Shortly after, the patient’s 83-year-old husband developed symptoms of dysarthria, gait ataxia, vertigo, and delirium.
Conclusion: Anticholinergic syndrome consists of a combination of central and peripheral anticholinergic symptoms. Physostigmine given intravenously resulted in rapid reversal of symptoms. Thorn apple seeds had been accidentally ingested and were identified as the cause.

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    Published: 2024-03-28
    Issue: 2024: Vol 11 No 4 (view)

    How to cite:
    1.
    van Gastel P, Dijkstra JN, Jacob MA, Schouten JA, Kok B. Anticholinergic toxidrome due to thorn apple seed ingestion in an elderly couple. EJCRIM 2024;11 doi:10.12890/2024_004381.