This syndrome consists of fever, rash, peripheral leukocytosis, lymphadenopathy, and occasionally hepatic necrosis.Hyperammonemic encephalopathy was reported by Katano Hiroyuki of the Nagoya City Higashi General Hospital in early 2002 in a patient who had been stable on primidone monotherapy for five years before undergoing surgery for astrocytoma, a type of brain tumor. Additionally, her phenobarbital levels were inexplicably elevated post-surgery. This is much more common with the valproates than with any of the barbiturates. A randomized controlled trial whose results were published in the July 1985 issue of The New England Journal of Medicine found that primidone was more likely to cause impotence than phenytoin, carbamazepine, or phenobarbital. Like phenytoin, primidone is rarely associated with lymphadenopathy. Primidone can also cause vomiting; this happens in 1.0–0.1% of users. Overdose
The most common symptoms of primidone overdose are coma with loss of deep tendon reflexes and, during the recovery period, if the patient survives, disorientation, dysarthria, nystagmus, and ataxia, lethargy, somnolence, vomiting, nausea, and occasionally, focal neurological deficits which lessen over time. Complete recovery comes within five to seven days of ingestion. The symptoms of primidone poisoning have generally been attributed to its biotransformation to phenobarbital; however, primidone has toxic effects independent of its metabolites in humans. The massive crystalluria that sometimes occurs sets its symptom profile apart from that of phenobarbital. The crystals are white, needle-like, shimmering, hexagonal plates consisting mainly of primidone.In the Netherlands alone, there were thirty-four cases of suspected primidone poisoning between 1978 and 1982.
The authority performed the service about six times a year.The Maryland Transportation Authority previously offered a similar service for crossing the Chesapeake Bay Bridge, but that role is now filled by private companies.The Mackinac Bridge Authority, which oversees the Mackinac Bridge connecting Michigans Upper and Lower peninsulas, will drive needy gephyrophobiacs cars across the bridge for a nominal fee. Some one thousand drivers take advantage of this program annually. Leslie Ann Pluhar had her Yugo blown off the bridge in 1989. Later investigation concluded she had stopped her car over the open steel grating on the bridges span and that a gust of wind blowing through the grating pushed her vehicle off the bridge, but this assertion is not supported by recorded wind speed measurements taken on and around the bridge at the time of the accident. In media
Gephyrophobia is the main plot in "The Bridge" episode of The Middle. The character Brick is plagued by the phobia. In 1965s A Charlie Brown Christmas, Lucy references gephyrophobia (albeit with a slight mispronunciation) when attempting to diagnose Charlie Browns problems at her psychiatric help stand. See also
Galloping Gertie
List of bridge disasters
List of structural failures and collapses
List of phobias


== References ==