Table 1.
Summary of encephalopathy cases associated with bismuth subsalicylate
| References | Age (years) | Sex | Presentations | Investigation | Outcome |
|---|---|---|---|---|---|
| Hasking GD. et al. (1982) [15] | 60 | M | Use of bismuth subsalicylate over some years. Dysarthria, ataxia, incontinence, and twitches. | Hight bismuth levels in urine and serum. | Full recovery in moths. |
| Mendelowitz PC. et al. (1990) [16] | 45 | M | 7 days of bismuth large doses. Lethargy, dysarthria and myoclonic jerking that progressed to coma. | Hight bismuth levels in urine and serum. CT scan unremarkable. | Death. |
| Jungreis AC, et al. (1993) [17] | 68 | F | 2 years of bismuth use. Tremor, myoclonic jerks, unsteady gait, confusion. | High serum level 6 weeks after stopping. | Recovery in 6 months. |
| Gordon MF. et al. (1995) [18] | 54 | M | Use of bismuth subsalicylate intermittently over many years. 6-week history of progressive confusion and a 2–3-week history of marked multifocal myoclonic jerks, postural tremors, postural instability, and gait ataxia. | Hight bismuth levels in urine and serum. EEG with bihemispheric slowing. MRI unremarkable. | Gradual recovery. Bismuth levels normalized after 12 weeks. |
| Reynolds PT. et al. (2012) [19] | 56 | F | 2 moths of bismuth use. Psychomotor retardation, poor concentration, drowsy, visual hallucinations, tremor, myoclonic jerks and postural instability. | Hight bismuth levels in urine and serum. Slightly elevated white blood cell count in CSF. MRI unremarkable. | Full recovery in several months. |
| Masannat Y. et al. (2013) [20] | 56 | F | Weeks of bismuth use. Progressive confusion for two weeks, followed by myoclonus, tremors, gait instability and visual hallucinations. | Hight bismuth levels in urine and serum. CT scan, MRI, EEG and CSF were unremarkable. | Full recovery 4 months post discharge. |
| Siram R. et al. (2017) [21] | 25 | F | Hight bismuth doses for 15–20 days. Tinnitus, hearing loss (likely concurrent salicylate toxicity), encephalopathy, ataxia and myoclonus. | Hight serum bismuth levels. MRI with thalamic and basal ganglia signal changes, cerebral and cerebellar atrophy. | Improved over 2 months with residual hearing loss, cerebellar signs and dystonia. |
| Ali F. et al. (2017) [7] | 54 | F | 2 years of bismuth use. 3-month history of progressive dementia, myoclonus, and ataxia | Hight bismuth levels in urine and serum. FDG-PET brain with diffuse mildly reduced uptake. | Marked recovery after withdrawal. |
| Hogan DB. et al. (2018) [6] | 77 | F | Long-term and uninterrupted consumption of bismuth subsalicylate. Impaired balance and gait, tremors and cognitive deficits. | Hight urine bismuth levels. | Marked recovery 1 month after withdrawal. |
M: Male; F: Female