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Sustained Clonus in Serotonin Syndrome

- Dr. David Juurlink @DavidJuurlink

#Clonus #serotonin #syndrome #PhysicalExam #Clinical #Video #Knee #Reflexes
Sustained Clonus ... in Serotonin Syndrome ... DavidJuurlink #Clonus ... #serotonin #syndrome
Clinical Manifestations of Serotonin Syndrome
 • Ophthalmologic: Mydriasis, Ocular clonus (slow horizontal movements)
 • Gastrointestinal: Diarrhea,
Manifestations of Serotonin Syndrome ... Mydriasis, Ocular clonus ... agitated), Tremor, Clonus ... (sustained), Clonus ... ucsdim #Serotonin #Syndrome
Algorithm for the Diagnosis of Serotonin Syndrome
 - Serotonin syndrome is thought to be caused by
- Serotonin syndrome ... hyperreflexia, inducible clonus ... myoclonus, ocular clonus ... , spontaneous clonus ... Hyperreflexia, clonus
Selective Serotonin Reuptake Inhibitors: Mechanisms and Side Effects
 • Serotonin Syndrome:
   - Autonomic Hyperactivity:
• Serotonin Syndrome ... Abnormalities: Ocular Clonus ... Hyperreflexia, Muscle clonus ... SSRI Withdrawal Syndrome
Characteristics of Serotonin Syndrome and Other Hyperthermic Syndromes 
Serotonin Syndrome
 - SSRIs, second-generation antidepressants, MAOIs, linezolid,
Characteristics of Serotonin Syndrome ... Other Hyperthermic Syndromes ... Serotonin Syndrome ... hyperreflexia, tremor,clonus ... #Hyperthermic #Syndromes
Serotonin Syndrome
 - Rapid onset 
 - Combination of 2+ serotonin agonists 
Mental status changes:
Serotonin Syndrome ... abnormalities: - Clonus ... #Serotonin #Syndrome
Serotonin-Norepinephrine Reuptake Inhibitors(SNRIs): Mechanisms and Side Effects

Withdrawal: Dizziness, Diarrhea, Insomnia, Nausea, Vomiting
Serotonin Syndrome - Potentially Life
Vomiting Serotonin Syndrome ... Abnormalities: Ocular Clonus ... Hyperreflexia, Muscle clonus
Serotonin Syndrome: Pathogenesis and Clinical Findings
Serotonin Syndrome: Variable combination of mental status changes, autonomic instability, and
Serotonin Syndrome ... Findings Serotonin Syndrome ... - Spontaneous clonus ... or inducible clonus ... #Serotonin #Syndrome
Antiphospholipid Syndrome (Hughes' Syndrome) 
Antiphospholipid syndrome - an autoimmune condition where the affected individual produces antibodies
Antiphospholipid Syndrome ... (Hughes' Syndrome ... Antiphospholipid syndrome ... arterial/venous blood clots ... #Hughes #Syndrome
Causes of Seizures - Differential Diagnosis Algorithm
Unprovoked - Epilepsy:
 • Focal: Simple, Complex
 • Generalized: Absence,
Myoclonic, Tonic, Clonic ... Atonic, Tonic-clonic ... vasoconstriction syndrome