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Feeling Dizzy, Weak, Irritable, And Sleepy. MRI Showed Swelling Of Dura. Taking Primidone. Side Effect?
Question: My husband has been taking primidone for about a year. He also takes Multaq, Warfarin, Crestor, Pristiq, Finasteride, and Flomax. He is 85 years of age.Suddenlyhe became dizzy, weak, irritable, and slept quite a bit of the time. An MRI was done of his head and it showed a small swelling of the dura. A Catscanof his spine was done and he ha s dome arthritis and spurs but nothing since his last catscan of the spine. It appears to me from reading that the primidone might be the source of his trouble. Can primidone stay in your body and build up? He was diagnosed with myelitis about 7 year ago but is spry and works at a tennis club and sometimes plays doubles. He has done well after his valve replacement some 14 years ago.
Hi,
Thank you for writing in.
From your query, I read that your husband had a prior history of valve replacement, atrial fibrillation controlled, prior myelitis with above mentioned drugs, CATscan spine which revealed mild changes in spine and MRI showing dural swelling of unknown cause.
Now he had sudden dizziness, irritability and slept quite a bit. These symptoms do not go with primidone side effects. Though primidone can produce dizziness, imbalance and drowsiness, but that should be continuous and gradual onset rather then sudden onset and short duration. Secondly primidone has a plasma half life of 7 to 14 hours. This drug is metabolized into phenobarbitone and phenylethylmalonamide, and 40% of drug is excreted unchanged in urine. The rest 60% is also excreted via urine as its metabolites. Complete turn over of the drug occurs by a week. So I primadone is in no way responsible.
Small swelling of the dura noted on the MRI scan can occur due to inflammation or the bleed. Has any such cause mentioned on the scan. If possible can you upload detailed MRI brain reports/image on this page using the site's downloader. If you wish you can mail the images/reports to YYYY@YYYY with subject as "Attn: Dr. Sandhya Monorenj".
As dural swelling can cause sudden abnormal behaviour like irritability weak and dizzy followed by drowsiness (a type of fits), the link needs to be evaluated. As he is on warfarin and warfarrin can cause minordural bleed, that would be my strong suspicion. So if he was my patient here I would suggest MRI brain with contrast with Gradient echo sequence (to know if bleed is the cause of swelling its duration, or is the swelling of dura due to inflammation / infection. I would also order for Prothrombin time, serum electrolytes, urine phenobarbitone level and EEG (to rule out seizure).
In brief he requires neurological assessment . It might be worthwhile to consult a neurologist and plan the aforementioned tests.
Hope this will help you. Let me know if you need clarifications.
Regards
DR Sandhya Manorenj
Neurologist
Hyderabad
Thank you for writing in.
From your query, I read that your husband had a prior history of valve replacement, atrial fibrillation controlled, prior myelitis with above mentioned drugs, CATscan spine which revealed mild changes in spine and MRI showing dural swelling of unknown cause.
Now he had sudden dizziness, irritability and slept quite a bit. These symptoms do not go with primidone side effects. Though primidone can produce dizziness, imbalance and drowsiness, but that should be continuous and gradual onset rather then sudden onset and short duration. Secondly primidone has a plasma half life of 7 to 14 hours. This drug is metabolized into phenobarbitone and phenylethylmalonamide, and 40% of drug is excreted unchanged in urine. The rest 60% is also excreted via urine as its metabolites. Complete turn over of the drug occurs by a week. So I primadone is in no way responsible.
Small swelling of the dura noted on the MRI scan can occur due to inflammation or the bleed. Has any such cause mentioned on the scan. If possible can you upload detailed MRI brain reports/image on this page using the site's downloader. If you wish you can mail the images/reports to YYYY@YYYY with subject as "Attn: Dr. Sandhya Monorenj".
As dural swelling can cause sudden abnormal behaviour like irritability weak and dizzy followed by drowsiness (a type of fits), the link needs to be evaluated. As he is on warfarin and warfarrin can cause minordural bleed, that would be my strong suspicion. So if he was my patient here I would suggest MRI brain with contrast with Gradient echo sequence (to know if bleed is the cause of swelling its duration, or is the swelling of dura due to inflammation / infection. I would also order for Prothrombin time, serum electrolytes, urine phenobarbitone level and EEG (to rule out seizure).
In brief he requires neurological assessment . It might be worthwhile to consult a neurologist and plan the aforementioned tests.
Hope this will help you. Let me know if you need clarifications.
Regards
DR Sandhya Manorenj
Neurologist
Hyderabad
Above answer was peer-reviewed by :
Dr. Prasad
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