Evidence map›Paper›PMID 41694160›Full record

ArticleCase reports in neurological medicine2026

Cerebral Edema Secondary to Heavy Metal Toxicity From Siddha Medicine: A Case Report and Case-Based Review.

Zhibin Tan, Bernard Ji Guang Chua, Mingwei Ng, Sophia Reyes, Stella Setiawan, You Jiang Tan, Boon Kiat Kenneth Tan, Ponampalam R

Abstract read
In one paragraph

Article in Case reports in neurological medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Zhibin TanDepartment of Neurology, National Neuroscience Institute, Singapore, nni.com.sg.ORCID https://orcid.org/0009-0001-4413-708X
Bernard Ji Guang ChuaDepartment of Oncology, National Cancer Centre Singapore, Singapore, nccs.com.sg.ORCID https://orcid.org/0000-0002-4781-3266
Mingwei NgDepartment of Emergency Medicine, Singapore General Hospital, Singapore, sgh.com.sg.ORCID https://orcid.org/0000-0003-0614-2061
Sophia ReyesDepartment of Oncology, National Cancer Centre Singapore, Singapore, nccs.com.sg.ORCID https://orcid.org/0000-0002-7250-2849
Stella SetiawanDepartment of Neurology, National Neuroscience Institute, Singapore, nni.com.sg.ORCID https://orcid.org/0000-0002-4950-829X
You Jiang TanDepartment of Neurology, National Neuroscience Institute, Singapore, nni.com.sg.ORCID https://orcid.org/0000-0002-0091-5599
Boon Kiat Kenneth TanDepartment of Emergency Medicine, Singapore General Hospital, Singapore, sgh.com.sg.ORCID https://orcid.org/0000-0003-2167-690X
Ponampalam RDepartment of Emergency Medicine, Singapore General Hospital, Singapore, sgh.com.sg.ORCID https://orcid.org/0000-0002-5813-2044

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: Traditional Indian medicine has been used to treat a variety of illnesses for centuries. However, there are existing concerns surrounding its heavy metal content. Amongst the different systems of traditional Indian medicine, Ayurvedic medicine has been most frequently implicated in heavy metal toxicity, while Siddha medicine has only very rarely been reported in association with lead and mercury poisoning. Case Presentation: A 58-year-old woman presented twice with severe headache, vomiting, dysphasia, truncal ataxia, and tremors. In the second presentation, she also had a clinical seizure. Both times, brain imaging showed diffuse gyral edema, but blood and cerebrospinal fluid tests were unyielding for any explanatory biochemical or serological causes. Both times, the patient displayed clinical and radiologic improvement during her inpatient stay, without any definitive treatment instituted. Eventually, a history of daily Siddha medicine usage for 3 months prior to presentation, as well as in the intervening period between both admissions, was elicited. Blood tests showed high lead levels beyond the assay's limit for accurate quantification. Pharmaceutical analysis of her Siddha medicine capsules revealed contents of arsenic, mercury, and lead at levels that were several thousand times the safe limits. She was treated with oral dimercaptosuccinic acid with significant improvement in symptoms. Conclusion: We presented an unusual case of generalized cerebral edema caused by multiple metal toxicity from Siddha medicine use. Our case illustrates that Siddha medicine can cause a mixed toxidrome with toxicities from multiple metals at once. Our patient's highly unusual presenting syndrome, including diffuse cerebral edema on brain imaging and triphasic waves on electroencephalogram, will hopefully be informative for physicians faced with similar cases in future.

Indexed as

arseniccerebral edemaleadmercurypoisoningSiddhatoxicity

Identifiers

PMID41694160
PMCPMC12902456

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.