1Department of General Medicine, Sree Balaji Medical College and Hospital, Chennai, India. Email: erigelamallikarjuna@gmail.com ORCID: 0009-0009-4384-6202
2Department of General Medicine, Sree Balaji Medical College and Hospital, Chennai, India. Email: sureshkannatmc@gmail.com ORCID: 0000-0001-7088-3003
3Department of General Medicine, Sree Balaji Medical College and Hospital, Chennai, India. Email: rarvind2007@gmail.com ORCID: 0000-0002-4820-5369
4Department of General Medicine, Sree Balaji Medical College and Hospital, Chennai, India. Email: akitagopinathgopal@gmail.com ORCID: 0009-0004-6699-3700
5Department of General Medicine, Sree Balaji Medical College and Hospital, Chennai, India. Email: prakashkmc12@gmail.com ORCID: 0009-0000-7535-1045X
Received: 14th Dec, 2025; Revised: 11th Feb 2026; Accepted: 12th Feb, 2026; Available Online: 3rd Mar, 2026
Introduction: Lithium is a cornerstone therapy for bipolar disorder but has a narrow therapeutic index. Although acute lithium toxicity is usually reversible with timely hemodialysis, rare cases may progress to Syndrome of Irreversible Lithium-Effectuated Neurotoxicity (SILENT), characterized by persistent neurological deficits despite normalization of serum lithium levels [1–3].
Case Presentation: A 54-year-old man with bipolar affective disorder ingested approximately 16 g of lithium. Despite early hemodialysis and normalization of serum lithium levels, he developed persistent quadriplegia and mutism. Serial magnetic resonance imaging (MRI) of the brain revealed no lithium-specific structural abnormalities.
Conclusion: This case highlights SILENT syndrome presenting with severe neurological impairment and striking clinical–radiological dissociation. Normal serum lithium levels and unremarkable neuroimaging do not exclude irreversible neurotoxicity, underscoring the need for heightened clinical vigilance.
Keywords: Lithium toxicity, SILENT syndrome, irreversible neurotoxicity, clinical–radiological dissociation, hemodialysis, bipolar disorder
How to cite this article: Reddy EM, Subramaniam SK, Arvindraj R, Gopinath A, Gnanaprakash C. When Silence Persists: Syndrome of Irreversible Lithium-Effectuated Neurotoxicity (SILENT) Following Acute Lithium Overdose. Int J Drug Deliv Technol. 2026;16(2): 819. DOI: 10.25258/ijddt.16.1.88
Source of support: Nil.
Conflict of interest: None