J Neurocrit Care.  2020 Dec;13(2):109-114. 10.18700/jnc.200021.

Bupropion overdose as a clinically significant confounder of the neurological examination

• Reyes R
• Figueroa S

• KMID: 2509941
• DOI: http://doi.org/10.18700/jnc.200021

Abstract

Background
Bupropion is a selective dopamine and norepinephrine reuptake inhibitor utilized in the treatment of multiple neuropsychiatric conditions. It has been implicated as a brain death mimic due to its association with a comatose examination.
Case Report
A 31-year-old man with depression and anxiety ingested bupropion as part of a multi-drug overdose in a suicide attempt. During his hospital course, he suffered two cardiopulmonary arrests approximately 24 hours after ingestion. Neurological examination was excessively poor relative to imaging studies and was notable for absent brainstem reflexes. He was treated with targeted temperature management and lipid emulsion therapy with rapid improvement. He was eventually discharged after making a complete neurological recovery.
Conclusion
Bupropion is a unique clinical confounder and may be associated with a disproportionately poor neurological examination in the setting of intoxication. Many factors should be considered in the approach to evaluation, treatment, and prognostication of these patients.

Keyword

Bupropion; Coma; Overdose; Prognosis; Confounding variable; Ingestion

Figure

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  Fig. 1. Electrocardiogram on admission demonstrating normal sinus tachycardia. PR interval: 188 ms, QRS duration: 100 ms, corrected QT (QTc): 474 ms. aVR, augmented vector right; aVL, augmented vector left; aVF, augmented vector foot.

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  Fig. 2. Electrocardiogram immediately after cardiac arrests showing sinus tachycardia and new first degree atrioventricular block with slight QRS prolongation. PR interval: 256 ms, QRS duration: 144 ms, corrected QT (QTc): 495 ms. aVR, augmented vector right; aVL, augmented vector left; aVF, augmented vector foot.

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  Fig. 3. Head imaging before and after cardiac arrest. (A-C) A normal non-contrast computed tomography (CT) of the head obtained at admission with slices through the corona radiata and centrum semiovale. (D-F) Non-contrast CT of the head obtained 48 hours after cardiopulmonary arrest displaying interval development of sulcal effacement and subtle changes in grey-white matter differentiation at the level of the corona radiata and centrum semiovale.

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