The combination of lithium and neuroleptic is frequently used in the treatment of bipolar disorder. After a febrile episode, some patients exhibited neurological sequelae including cerebellar, pyramidal and extra-pyramidal signs. Lithium may be the main factor of neurotoxicity but hyperthermic states are probably involved in determining brain damage.

58 year-old Tunisian women with a medical history of bipolar disorder treated by combination of lithium carbonate (700 mg/day) and levomepromazine (50 mg/day), was presented to the hospital with complaint of fever, cough, walking instability, choreic and dystonic abnormal movements. Physical examination found a temperature of 39 C°, rhino- bronchial, cerebellar, pyramidal, and extra-pyramidal syndrome. The additional diagnostic tests such as brain scan, MRI brain and lumbar puncture were normal. Desperate the corticoid treatment the cerebellar syndrome persisted.

This case and some literature reviews illustrate the role of hyperthermic states in brain damage of the neuroleptics-lithium combination. Neuropathological findings showed selective degeneration of cerebellar purkinje cells. Research on this topic is recommended.