Serotonin Syndrome

47 y.o. female who presents with 1 week of tremor, increased rigidity and trouble walking. Pt recently had effexor dose increased on 10/11 and abilify dose increased in September. Abruptly stopped abilify 2 weeks ago. For last week has had a new tremor in all 4 extremities. Has also had shuffling gate and felt unsteady on her feet. She states she’s never had these sx before. Finally she describes some rib pain and mild abd pain. No fevers, chills, headache, vision changes, leg swelling, bruising, hematuria, dysuria, si, hi, neck pain, gland swelling. Due to persistent tremor and worsening ability to walk went to osh. At osh had neg head ct, cxr, ua, cbc, chemistry. Transferred here for further eval.
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Aortic Dissection

50yo M transfer from OSH with aortic dissection based on CT scan from carotids/proximal aorta (Type A) to iliacs bilaterally.  Sx were sudden-onset CP radiating to back and neck and presyncope.  No recent illnesses, abd pain.  Bradycardic on arrival (40’s) with stable BP, was on nitroprusside gtt.  Mental status was fluctuating but he was protecting his airway.  Cardiac surgery immediately consulted on arrival to TB.