# 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.

## Key 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.