International Journal of Clinical Pharmacology & Toxicology, 2013 © 102 P.N.Venkatarathnamma, M.N.Chandra Shekara, S.V.Srinivasa, Jagadish basavaih(2013) Phenytoin Induced Cerebellar Ataxia and Orofacial Dyskinesia in a Case of Disseminated Cysticercosis: A Case Report. Int J Clin Pharmacol Toxicol. 2:702, 102-105. International Journal of Clinical Pharmacology & Toxicology (IJCPT) ISSN 2167-910X Phenytoin Induced Cerebellar Ataxia and Orofacial Dyskinesia in a Case of Disseminated Cysticerco- sis: A Case Report Case Report P.N.Venkatarathnamma 1* , M.N.Chandra Shekara 2 , S.V.Srinivasa 3 , Jagadish basavaih 4 1* Professor of Medicine, Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, Karnataka, India. 2 Assistant Professor of Neurology, Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, Karnataka, India. 3 Assistant Professor of Medicine, Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, Karnataka, India. 4 Assistant Professor of Radiology, Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, Karnataka, India *Corresponding Author: P.N.Venkatarathnamma Professor of Medicine, Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, Karnataka, India. E-mail: drpnvr@rediffmail.com Received: September 15, 2013 Accepted: October 3, 2013 Published: October 7, 2013 Citation: P.N.Venkatarathnamma, M.N.Chandra Shekara, S.V.Srinivasa, Jagadish basavaih(2013) Phenytoin Induced Cerebellar Ataxia and Orofacial Dyskinesia in a Case of Disseminated Cysticercosis: A Case Report. Int J Clin Pharmacol Toxicol. 2:702, 102-105. Copyright: P.N.Venkatarathnamma © 2013. This is an open-access ar- ticle distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited. Introduction Phenytoin is a hydantoin compound related to the barbiturates that are used for the treatment of seizures. Nystagmus, ataxia, and drowsiness, are the most frequently encountered dose-related side effects of phenytoin toxicity and are correlated with plasma levels. It was revealed that in the majority of the patients, nystag- mus, ataxia, and drowsiness appear when plasma levels reach 20, 30, and 40 mcg/dL, respectively, but dose-related side effects may show a great diversity among patients.[1] Cysticercosis is caused by cysticercus cellulosae, the larval form of the tapeworm Taenia solium. Humans acquire cysticercosis through faeco-oral contamination with taenia solium eggs from tapeworm carriers. Disseminated cysticercosis is an uncommon manifestation of this common disease.[2] Widespread dissemi- nation of the cysticerci can result in involvement of almost any organ of the body including the central nervous system, skeletal muscles, subcutaneous tissue, and the eyes. Neurocysticercosis, is a pleomorphic disease whose clinical manifestations vary with the number, size, location and stage of cysticerci as well as the inten- sity of the host’s immune response.[3]Common manifestations include intractable seizures, cognitive decline, cerebellar ataxia, fo- cal neurological signs, hydrocephalus and features of spinal cord compression. Case Report A 25 year old male, resident of a rural place near Kolar (Karna- taka, India), an employee at a cold storage, was on treatment with phenytoin for history of recurrent seizures (generalized tonic clonic type) for one year duration. Now he presented with giddi- ness, vomiting, unsteady gait and slurring of speech of one week. He is a non vegetarian (consumes pork). There was no relevant past medical history. The patient had not undergone any prior ra- dio imaging and was on Tablet phenytoin - 300mg/day in divided doses started by a private practitioner. On examination the patient had multiple subcutaneous nodules over the right cheek, neck and upper trunk (Figure.1). Neurologi- cal examination revealed a wide based ataxic gait, scanning dys- arthria, horizontal gaze nystagmus, bilateral cerebellar signs (left more than right) and occasional choreiform movements involving the left upper limb and orofacial dyskinesias. Routine laboratory examination was unremarkable except for a macrocytic normochromic blood picture. Computed tomography of the brain showed multiple hypodense lesions with central hy- perdensity (more than 100 in number), noted diffusely in the brain parenchyma, largest measuring 3x2 cms in the left frontal region, and was suggestive of infective granulomas. (Figure 2) MRI showed multiple lesions throughout the brain parenchyma in both cerebral hemispheres, cerebellar hemispheres, brain stem and spinal cord. The lesions were also noted in the intramuscular Abstract We report a 25 year old male patient who developed phenytoin induced cerebellar ataxia and orofacial dyskinesias that re- solved after discontinuation of phenytoin. This patient also had disseminated cysticercosis, i.e. diffuse involvement of the brain, spinal cord, intramuscular and subcutaneous tissues. This case report is interesting because cerebellar ataxia is a known manifestation of both neurocysticercosis and phenytoin toxicity, while it is reversible in case of phenytoin toxicity. Key Words: Phenytoin Toxicity; Cerebellar Ataxia; Disseminated Cysticercosis