Ataxia Bismuth

From 1973 onward many cases of an encephalopathy were reported among bismuth users. By 1979, 945 cases had been recorded in France alone, 72 of them fatal the worldwide total exceeded 1000 cases. Bismuth encephalopathy is characterized by ataxia, confusion, speech disorder, and myoclonus. The subgaUate and oxychloride have been imphcated, as has the subcitrate when used in a patient... 

Since the first reports from Australia and the observations in France (26 ) encephalopathy has been irrefutably shown to be a complication, not only of bismuth subgallate but also of other bismuth salts such as the subnitrate, carbonate and silicate. More than a hundred cases of bismuth encephalopathy have now been reported. The prodromal stage of bismuth encephalopathy is characterized by headache, insomnia, impairment of mental functions, asthenia and confu-sional states. After some time an overt encephalopathy develops abruptly, generally characterized by (1) psychosis, often with excitation and hostility, and finally coma, (2) myoclonic jerks, progressing to myoclonic crises, (3) ataxia and dysarthria, and (4) convulsions if generalized, these states are often resistant to anticonvulsant drugs. 

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