{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T12:56:45Z","timestamp":1791205005411,"version":"4.1.0"},"reference-count":3,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["PCN Reports"],"published-print":{"date-parts":[[2026,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Acute lithium intoxication can cause severe central nervous system (CNS) manifestations, sometimes leading to long\u2010term sequelae known as the syndrome of irreversible lithium\u2010effectuated neurotoxicity (SILENT). However, its underlying pathophysiology remains unclear. We report a case of acute lithium encephalopathy presenting with elevated myelin basic protein (MBP) levels in the cerebrospinal fluid (CSF), offering insights into its pathogenesis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>A 50\u2010year\u2010old man with schizophrenia developed coma following acute lithium intoxication. Two days prior to symptom onset, his serum lithium concentration had reached a toxic level of 3.95 mEq\/L, prompting immediate drug discontinuation. Electroencephalography (EEG) demonstrated generalized rhythmic delta activity (GRDA) with triphasic morphology, characteristic of lithium encephalopathy, but not fulfilling the criteria for non\u2010convulsive status epilepticus. A lumbar puncture on Day 6 revealed an elevated CSF MBP level of 141\u2009pg\/mL (normal, &lt;102\u2009pg\/mL) without pleocytosis or an elevated IgG index. Although his serum lithium concentration dropped below 0.1 mEq\/L by Day 8, his altered mental status was prolonged. His consciousness gradually improved from Day 10, but neurological deficits including dysarthria, gait instability, and intention tremor persisted until Day 40 before fully resolving.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The elevated CSF MBP level suggests that toxic lithium exposure may induce CNS demyelination. While the clinical symptoms were reversible in this patient, such a mechanism may underpin the prolonged or permanent neurological deficits seen in SILENT.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pcn5.70422","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T12:44:31Z","timestamp":1791204271000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A case of acute lithium encephalopathy associated with elevated myelin basic protein levels in cerebrospinal fluid"],"prefix":"10.1002","volume":"5","author":[{"given":"Teruo","family":"Yokoyama","sequence":"first","affiliation":[{"name":"Department of Neurology Komagino Hospital Hachioji Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takuya","family":"Hashimoto","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Komagino Hospital Hachioji Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasushi","family":"Moriyama","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Komagino Hospital Hachioji Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5608-423X","authenticated-orcid":false,"given":"Aihide","family":"Yoshino","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Komagino Hospital Hachioji Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,5]]},"reference":[{"issue":"1","key":"e_1_2_12_2_1","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1097\/01.wnf.0000150871.52253.b7","article-title":"The syndrome of irreversible lithium\u2010effectuated neurotoxicity","volume":"28","author":"Adityanjee","year":"2005","journal-title":"Clin Neuropharmacol"},{"issue":"1","key":"e_1_2_12_3_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/WNP.0000000000000806","article-title":"American Clinical Neurophysiology Society's standardized critical care EEG terminology: 2021 version","volume":"38","author":"Hirsch LJ","year":"2021","journal-title":"J Clin Neurophysiol"},{"issue":"12","key":"e_1_2_12_4_1","doi-asserted-by":"crossref","first-page":"2071","DOI":"10.1111\/j.1528-1167.2006.00849.x","article-title":"Lithium\u2010induced confusional states: nonconvulsive status epilepticus or triphasic encephalopathy?","volume":"47","author":"Kaplan PW","year":"2006","journal-title":"Epilepsia"}],"container-title":["Psychiatry and Clinical Neurosciences Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pcn5.70422","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/pcn5.70422","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pcn5.70422","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T12:44:32Z","timestamp":1791204272000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pcn5.70422"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,5]]},"references-count":3,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,12]]}},"alternative-id":["10.1002\/pcn5.70422"],"URL":"https:\/\/doi.org\/10.1002\/pcn5.70422","archive":["Portico"],"relation":{},"ISSN":["2769-2558","2769-2558"],"issn-type":[{"value":"2769-2558","type":"print"},{"value":"2769-2558","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,5]]},"assertion":[{"value":"2026-07-25","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-25","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-05","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70422"}}