Supra-bulbar symptoms

Typical symptoms of lithium intoxication are summarized in Table 2 [122-127]. The clinical picture of hthium intoxication is dominated by neuromuscular and cerebral symptoms in mild cases apathy, muscle weakness, tremor, and unsteady gait are seen. In more severe cases speech disturbances, myoclonic twitching, coma and convulsion can occur. Pulse irregularities and circulatory collapse may supervene. Lithium often causes T-wave flattening or inversion on the electrocardiogram, but clinically important cardiovascular effects are rare, with sinus-node dysfunction reported most often [123]. Residual neurological sequelae consisting of cerebellar dysfunction with ataxia, neuropathy and supra-bulbar symptoms are not unusual. 

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