warfarin and Ataxia

Isolated brachiocephalic artery dissection is an extremely rare condition. Its presentation as an acute stroke can pose a significant diagnostic challenge in patients because of its rarity. We present a case of isolated spontaneous brachiocephalic artery dissection presenting as acute cerebrovascular accident. This case also illustrates the treatment dilemma brachiocephalic artery dissection can present, whether to choose antithrombotic/anticoagulation therapy and/or surgery, and also the dilemma in blood pressure management.

Topics: Adult; Anticoagulants; Antihypertensive Agents; Aortic Dissection; Aspirin; Ataxia; Brachiocephalic Trunk; Heparin; Humans; Male; Medical History Taking; Obesity; Platelet Aggregation Inhibitors; Stroke; Warfarin

The cytochrome P450 enzyme CYP2C9 metabolizes several important drugs, such as warfarin and oral antidiabetic drugs. The enzyme is polymorphic, and all known alleles, for example, CYP2C9*2 and*3, give decreased activity. Ultra-high activity of the enzyme has not yet been reported.. We present a patient with Behçet's disease who required treatment with high doses of phenytoin. When fluconazole, a potent inhibitor of CYP2C9, was added to the treatment regimen, the patient developed ataxia, tremor, fatigue, slurred speech and somnolence, indicating phenytoin intoxication. On suspicion of ultra-high activity of CYP2C9, a phenotyping test for CYP2C9 with losartan was performed.. The patient was shown to have a higher activity of CYP2C9 than any of the 190 healthy Swedish Caucasians used as controls.. Our finding of an ultrarapid metabolism of losartan and phenytoin may apply to other CYP2C9 substrates, where inhibition of CYP2C9 may cause severe adverse drug reactions.

Topics: Alleles; Angiotensin II Type 1 Receptor Blockers; Anticonvulsants; Aryl Hydrocarbon Hydroxylases; Ataxia; Behcet Syndrome; Case-Control Studies; Cytochrome P-450 CYP2C9; Cytochrome P-450 Enzyme System; Disorders of Excessive Somnolence; Dose-Response Relationship, Drug; Fatigue; Female; Fluconazole; Humans; Losartan; Middle Aged; Pharmaceutical Preparations; Phenotype; Phenytoin; Polymorphism, Genetic; Speech Intelligibility; Warfarin

Topics: Adult; Anticoagulants; Ataxia; Cerebellar Diseases; Cerebellum; Female; Humans; Indians, North American; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Manipulation, Spinal; Medicine, Traditional; Recovery of Function; Stroke; Vertebral Artery Dissection; Vertigo; Warfarin

To assess the incidence of adverse effects associated with long-term amiodarone therapy, we reviewed the records of 217 consecutive patients who were treated for refractory arrhythmia. After an average of 11.8 months of therapy, one or more side effects occurred in 113 patients (52%). These were considered clinically significant in 42 patients (19.3%), mandating discontinuation of amiodarone in 18 (8.3%). The untoward reactions requiring discontinuation of amiodarone included thyroid dysfunction, visual disturbances, pulmonary infiltrates, ataxia, cardiac conduction abnormalities, and drug interactions. The mild side effects included corneal microdeposits, skin rashes, and gastrointestinal symptoms. There was a weak correlation between blood levels of amiodarone, the daily dose, and the cumulative dose (r = 0.23, p = 0.015). Drug levels were higher in symptomatic patients (p less than 0.03), although they received lower doses of amiodarone. While amiodarone is associated with frequent side effects, they are generally mild and do not necessitate drug discontinuation. Careful monitoring of therapy is essential to detect the potentially serious adverse reactions which are encountered in nearly 20% of patients.

Topics: Amiodarone; Arrhythmias, Cardiac; Ataxia; Benzofurans; Drug Eruptions; Drug Interactions; Female; Gastrointestinal Diseases; Humans; Male; Middle Aged; Respiratory Tract Diseases; Thyroid Diseases; Time Factors; Vision Disorders; Warfarin

Topics: Adult; Angiography; Ataxia; Carotid Arteries; Female; Humans; Ischemic Attack, Transient; Male; Middle Aged; Subclavian Steal Syndrome; Vascular Diseases; Vertebral Artery; Vertigo; Warfarin