From the Guidelines
The patient should immediately discontinue Wellbutrin XR and undergo further neurological evaluation, including an MRI of the brain with contrast, due to the concerning CT finding of extra-axial fluid collection or acute cortical infarct. The temporal relationship between the symptom onset and the Wellbutrin dose increase from 150 mg to 300 mg suggests that the medication may be contributing to her symptoms of dizziness, nausea, and lightheadedness 1. However, the CT finding takes precedence, and urgent evaluation is necessary to characterize the nature of the extra-axial fluid collection or potential acute cortical infarct.
A complete neurological examination, including vestibular testing, should be performed to assess for any focal neurological deficits. Laboratory tests, such as complete blood count, comprehensive metabolic panel, coagulation studies, and inflammatory markers, would be appropriate to rule out other potential causes of her symptoms. The combination of Wellbutrin and hormonal contraceptives should be reviewed, as both can potentially affect cerebrovascular risk.
Key considerations in the management of this patient include:
- Immediate discontinuation of Wellbutrin XR
- Further imaging with MRI of the brain with contrast
- Complete neurological examination
- Laboratory tests to rule out other causes
- Review of the combination of Wellbutrin and hormonal contraceptives
- Potential need for vascular imaging (MRA/CTA) if an infarct is confirmed
The patient should be closely monitored for worsening neurological symptoms and advised to report any new or worsening symptoms immediately, particularly headache, visual changes, or focal neurological deficits, which would warrant emergency evaluation.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Patient Symptoms and History
- The patient is a 22-year-old female experiencing symptoms of dizziness, nausea, and lightheadedness after increasing her Wellbutrin XR dosage from 150 mg to 300 mg.
- She has been taking birth control pills for 3 months.
- The Dix-Hallpike test was not strongly positive.
- Ophthalmology adjusted her prescription glasses.
- A CT head scan showed an extra-axial fluid collection or acute cortical infarct.
Next Steps
- Consider the potential relationship between the increased Wellbutrin XR dosage and the patient's symptoms, as well as the possible effects of birth control pills 2.
- Given the CT head scan results, it is essential to determine the best course of action for managing the extra-axial fluid collection or acute cortical infarct. A study on extra-axial fluid collections after decompressive craniectomy suggests that early bone flap restoration with simultaneous drainage may be associated with earlier resolution of extra-axial fluid collections 3.
- Another study provides a primer on interpreting head CT scans, which may be helpful in understanding the patient's scan results and guiding further management 4.
- It is also important to consider the potential risks and benefits of temporarily discontinuing medications in the event of an intercurrent illness, although the evidence base for this is limited 5.
- The prognosis of axial vs. extra-axial lesions on functional status after traumatic brain injury may not be directly relevant to this patient's case, but it is worth noting that one study found no evidence to support the hypothesis that axial injury is related to worse functional independence compared to extra-axial injury 6.