Supraversión de la mirada en intoxicación mortal por bupropión / Sustained upgaze in a patient who ingested high doses of bupropion: report of one case

Upgaze or sustained elevation of the eyes, is an alteration of ocular motility initially described in hypoxic coma. We report a 65-year-old woman admitted with hypotension and alteration of sensorium due to the ingestion of 9.5 g of Bupropion. She presented two seizures of short duration, without epileptic activity on the EEG. She had a persistent asynchronous myoclonus in extremities, tachycardia and prolonged Q-t. She suffered a cardiac arrest caused by asystole, which recovered quickly in five minutes. At that moment, upgaze appeared, associated with a persistent ocular opening, which persisted for days, but finally disappeared, without remission of coma. A magnetic resonance imaging done at the eighth day, showed hyperintensity of the oval center and corpus callosum which disappeared in a new imaging study done 30 days later, where images of hypoxia in the basal nuclei and cortex appeared. The patient died forty seven days after admission. Up-gaze is an ominous oculomotor alteration linked to an important but incomplete damage in the cerebral cortex, a condition that perverts some sequences of the ocular opening, reversing the Bell phenomenon and producing eyelid retraction.

Effects of nimodipine on multiunit activity of several brain structures following acute global cerebral ischemia-anoxia in cats

Se investigaron los efectos de nimodipina, una 1.4 dihidropiradina, bloqueador de los canales de calcio, sobre la actividad multineuronal (AMN) de varias estructuras cerebrales de gatos al aplicarse durante las 6 hrs siguientes a un estado de isquemia-anoxia cerebral global inducida por un paro cardiorespiratorio (PCR) de 10 min, así como en gatos expuestos a procedimientos control correspondientes al PCR. Se estudiaron cuatro grupos de gatos: 1 PCR y administración continua de nipodipina, 1 microg/kg/min iv durante 6 hrs; 2) PCR y administración continua del vehículo; 3) procedimietnos control y administración contínua de nipodipina 1 microg/kg/min iv durante 6 hrs; 4) procedimientos control y administración continua de vehículo. La AMN y el electroencefalograma desaparecieron durante el periodo de isquemia/anoxia; se recuperaron durante las horas siguientes al PCR, pero 6 hrs después del PCR la AMN era aún menor que sus valores previos al paro en todas las estructuras subcorticales que se registraron. Durante la recuperación de la actividad EEG se presentaron ondas delta, espigas aislada y trenes de ondas EEG rápidas (20 a 22 HZ). La nimodipina inhibió los aumentos de la AMN que de otro modo se hubieran presentado en la formación reticular mesencefálica, hipocampo y putamen, pero no en el hipotálamo ventromedial, en las horas siguientes al periodo de isquemia/anoxia cerebral global aguda. En los gatos sometidos a PCR y tratados con nimodipina no se observaron espigas aislada ni trenes de actividad EEG rápida. En los gatos control, no sometidos a PCR, la nimodipina redujo significativamente la AMN en el hipocampo pero no en otras estructuras cerebrales. Los resultados sugieren la participación de canales de calcio sensibles a 1,4-dihidropiridina en los mecanismos celulares relacionados con la actividad neuronal que se presenta después de la isquemia-anoxia, así como la posible relación entre los efectos de nimodipina sobre la AMN y las majores condiciones funcionales del sistema nervioso central después de un periodo de isquemia-anoxia cerebral global aguda.

Effect of Carbon Monoxide-Induced Hypoxia on Synaptosomal Uptake and Release of Dopamine in Rat Striatum

We studied the effect of carbon monoxide (CO)-induced hypoxia on synaptosomal uptake and release of dopamine (DA) in rat striatum. When the rats were intoxicated at a blood level of carboxyhemoglobin (HbCO), 60-70% for 3-4hrs, [3H] DA uptake was inhibited as much as 80% of control activity. This suppressed activity remained as long as 12 hrs after termination of the intoxication. After a week recovery period, the suppressed uptake activity was restored completely. When the rats were intoxicated maintaining a blood level of HbCO at 30-40% for 6-7hrs, the uptake was inhibited to 57% of the control actvity and this suppressed activity was restored within 12hrs. For the rats maintaining a blood level of HbCO at 15-25% for 6-7hrs, uptake inhibition was not shown. Acute CO intoxication(at 60-70% of HbCO for 3-4 hrs) caused an increase in K+-stimulated DA release to 147% of the control value. In conclusion, the diminished uptake and increased release of striatal DA in a CO intoxicated brain would cause an extraneuronal accumulation of DA with depletion of intraneuronal DA level, which may play a role in CO-induced hypoxic cell damage.