{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T12:29:20Z","timestamp":1790857760127,"version":"4.1.0"},"reference-count":13,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2004,10,12]],"date-time":"2004-10-12T00:00:00Z","timestamp":1097539200000},"content-version":"vor","delay-in-days":3513,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Movement Disorders"],"published-print":{"date-parts":[[1995,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Bismuth subsalicylate preparations are over\u2010the\u2010counter products for gastrointestinal complaints. Bismuth toxicity causes delirium, psychosis, ataxia, myoclonus, and seizures and is reversible over several weeks or months, when bismuth intake is stopped. We report a 54\u2010year\u2010old man with a 6\u2010week history of progressive confusion and memory difficulty and a 2\u20133\u2010week history of involuntary movements and gait impairment. His encephalopathy was further characterized by marked multifocal myoclonic jerks, coarse postural tremors, postural instability, and gait ataxia. He gradually improved. Extensive toxic, metabolic, and infectious workup demonstrated bismuth toxicity. Spinal tap and brain magnetic resonance scan were normal. Electroencephalography showed bihemispheric slowing. As his encephalopathy cleared, he reported using bismuth subsalicylate long term (daily intake of 8 oz). Bismuth levels 5 weeks after cessation of bismuth were elevated and normalized after 12 weeks. He followed a typical course for bismuth toxicity with subacute progressive encephalopathy and gradual recovery. Creutzfeldt\u2010Jakob was strongly considered due to his rapidly progressive encephalopathy, multifocal myoclonus, and ataxia. Due to its rarity, bismuth toxicity is often overlooked. We hope this presentation will increase recognition of bismuth toxicity. We believe more detailed labeling of bismuth products is needed to avoid similar toxicity from this readily available product.<\/jats:p>","DOI":"10.1002\/mds.870100215","type":"journal-article","created":{"date-parts":[[2005,5,28]],"date-time":"2005-05-28T20:14:51Z","timestamp":1117311291000},"page":"220-222","source":"Crossref","is-referenced-by-count":78,"title":["Bismuth subsalicylate toxicity as a cause of prolonged encephalopathy with myoclonus"],"prefix":"10.1002","volume":"10","author":[{"given":"Mark Forrest","family":"Gordon","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Russell Ira","family":"Abrams","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel B.","family":"Rubin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William B.","family":"Barr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denise D.","family":"Correa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2004,10,12]]},"reference":[{"key":"e_1_2_1_2_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.1.5901.220"},{"key":"e_1_2_1_3_2","first-page":"2315","article-title":"Encephalopathies myocloniques par les sels de bismuth","volume":"3","author":"Buge A","year":"1974","journal-title":"Nouve Presse Med"},{"key":"e_1_2_1_4_2","first-page":"401","article-title":"Encephalopathies myocloniques bismuthiques: formes evolutives complications tardives, durables ou definitives","volume":"133","author":"Buge A","year":"1977","journal-title":"Rev Neurol"},{"key":"e_1_2_1_5_2","first-page":"3531","article-title":"Encephalopathies bismuthiques: Donnees etologiques et epidemiologiques","volume":"739","author":"Buge A","year":"1978","journal-title":"Nouve Presse Med"},{"key":"e_1_2_1_6_2","first-page":"637","article-title":"Fatal salicylate toxicity from bismuth subsalicylate","volume":"155","author":"Sainsbury SJ","year":"1991","journal-title":"West J Med"},{"key":"e_1_2_1_7_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-112-2-140"},{"key":"e_1_2_1_8_2","doi-asserted-by":"crossref","first-page":"664","DOI":"10.5694\/j.1326-5377.1974.tb71076.x","article-title":"Adverse effects of bismuth subgallate: report of the Australian Drug Evaluation Committee","volume":"2","author":"Lowe DJ","year":"1974","journal-title":"Med J Aust"},{"key":"e_1_2_1_9_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.44.1.62"},{"key":"e_1_2_1_10_2","first-page":"244","article-title":"Bismuth toxicity","volume":"38","author":"Dipalma JR","year":"1988","journal-title":"Am Fam Practitioner"},{"key":"e_1_2_1_11_2","doi-asserted-by":"crossref","unstructured":"LambertJR. Pharmacology of bismuth\u2010containing compounds.Rev Infect Dis1991; (suppl 8):S691\u2013S695.","DOI":"10.1093\/clinids\/13.Supplement_8.S691"},{"key":"e_1_2_1_12_2","first-page":"1","article-title":"Definition and classification of myoclonus","volume":"43","author":"Fahn S","year":"1986","journal-title":"Adv Neurol"},{"key":"e_1_2_1_13_2","first-page":"251","article-title":"Druginduced myoclonus","volume":"43","author":"Klawans HL","year":"1986","journal-title":"Adv Neurol"},{"key":"e_1_2_1_14_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.43.6.1265"}],"container-title":["Movement Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fmds.870100215","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/movementdisorders.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/mds.870100215","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T12:17:31Z","timestamp":1760962651000},"score":1,"resource":{"primary":{"URL":"https:\/\/movementdisorders.onlinelibrary.wiley.com\/doi\/10.1002\/mds.870100215"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1995,3]]},"references-count":13,"journal-issue":{"issue":"2","published-print":{"date-parts":[[1995,3]]}},"alternative-id":["10.1002\/mds.870100215"],"URL":"https:\/\/doi.org\/10.1002\/mds.870100215","archive":["Portico"],"relation":{},"ISSN":["0885-3185","1531-8257"],"issn-type":[{"value":"0885-3185","type":"print"},{"value":"1531-8257","type":"electronic"}],"subject":[],"published":{"date-parts":[[1995,3]]}}}