Prior neurologic illness or CNS insult of any kind is known to increase the vulnerability to neurotoxicity of lithium. In this event the occurrence of neurotoxicity does not correlate with serum lithium levels. The authors describe a patient with hemiparesis who developed the syndrome of irreversible lithium-effectuated neurotoxicity (SILENT) while being treated with lithium for a manic episode. The authors review the literature on this aspect and highlight the dangers of starting lithium treatment in patients with neurologic impairment.
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