Overlooked Carbamazepine Toxicity: A Diagnostic Pitfall in an Elderly Patient With Dizziness

TL;DR

An elderly patient's dizziness was initially misdiagnosed as a balance issue but was later found to be caused by a drug toxicity.

Contribution

This case highlights the diagnostic challenge of mistaking carbamazepine toxicity for peripheral vertigo in elderly patients.

Findings

A 79-year-old man was misdiagnosed with peripheral vertigo before being found to have carbamazepine toxicity.

The case emphasizes the importance of monitoring carbamazepine levels and reviewing medications in elderly patients.

Carbamazepine toxicity can mimic central vertigo and lead to altered consciousness and involuntary movements.

Abstract

Dizziness is a common chief complaint that often poses a diagnostic challenge. A 79-year-old man was initially misdiagnosed with peripheral vertigo based on normal neuroimaging but later developed altered consciousness and involuntary limb movements, ultimately revealing carbamazepine (CBZ) toxicity. This case highlights a critical diagnostic pitfall: prematurely attributing dizziness to peripheral vertigo without considering drug-induced syndromes. Although the potential role of concomitant amiodarone use remains uncertain, this case also underscores the importance of cautious CBZ dose escalation, serum level monitoring, and a thorough medication review. Recognizing CBZ toxicity as a mimicker of central vertigo is crucial for ensuring timely and accurate diagnosis, especially in elderly patients.

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