Neurological Sequelae of Diagnostic and Therapeutic Procedures

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Adverse reactions to prescription or over-the-counter medications are a frequent cause of neurological morbidity and patient hospitalization. Therefore, it is essential that the possibility of an iatrogenic condition be considered in any patient presenting with acute, subacute, or chronic neurological symptoms. Identification of the responsible agent is simple when neurological symptoms are highly characteristic of the offending agent. However, in most cases, symptoms of intoxication are nonspecific and mimic neurological entities, or they exacerbate pre-existing neurological disease. Some effects relate directly to neurotoxicity, and others are secondary to damage of other organ systems such as renal or hepatic.

The nervous system may be adversely affected by several mechanisms. There may be interference with energy production necessary to maintain normal neural structure and function; exposure to foreign material may result in allergic or other immunological phenomena; drugs may affect the nervous system through their effects on neurotransmitters; the offending agent may interfere with nerve nutrition through involvement of the nutrient vessels; and alterations in acid-base balance or in ionic concentrations may occur. Advances in molecular biology research techniques are being applied to understanding the biochemical foundations of toxic reactions and to identifying subjects at risk of intoxication.

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