Nils Mein ^1* Khadija Mammadli ² Felix Luessi ² Timo Uphaus ^2*

• ¹ Friedrich Schiller University Jena, Jena, Germany
• ² Johannes Gutenberg University Mainz, Mainz, Rhineland-Palatinate, Germany

A 21-year-old Caucasian woman was admitted to our neurologic intermediate care unit after attempting suicide ingesting an estimated amount of 15 g venlafaxine (trevilor retard ®), adding up to a serum concentration of about 17943 µg/l. A brain magnetic resonance imaging (MRI) revealed bilateral cortical restricted-diffusion patterns indicating ischemic lesions. Here we report a case of venlafaxine-induced serotonin syndrome most likely cumulating in diffuse artery vasospasm due to an autonomic effect mediated by the serotoninergic and adrenergic system causing myocardial and cerebral injuries. The serotonin syndrome was treated symptomatically by administering fluids, benzodiazepines and by the management of hyperthermia using paracetamol, as well as medication with venlafaxine was stopped and hypoglycemia was treated. After 6 days our patient was discharged to the psychiatric facility with no remaining neurologic deficit.The case report provides evidence of ischemic strokes as a rare adverse event of venlafaxine intoxication. Further, we aim to increase awareness of hypoglycemia and epileptic seizures as complications of venlafaxine intoxication. Furthermore, we demonstrate important pitfalls in the diagnostic procedure and propose a treatment regimen for the underlying serotonin syndrome.