ABSTRACT
BACKGROUND: Lithium salts have been commonly used for prophylaxis and treatment of bipolar disorder and have numerous side effects. However, there has been no report of skew deviation and downbeat nystagmus associated with lithium. Herein, we report the first case of lithium-induced skew deviation and downbeat nystagmus. CASE PRESENTATION: A 39 years-old woman presented with intermittent vertical diplopia and dizziness within 1-2 months. Ophthalmologic examination revealed downbeat nystagmus and 6 prism diopters of right hypertropia. Funduscopic examination showed mild incyclotorsion on right eye. However, ductions and versions were within normal range. Other neurological examinations were also normal. She had a history of bipolar disorder treated with daily 600-900 mg of lithium for past 6 years, and 2 months before the first visit, daily dose of lithium was increased to 1200 mg. We referred the patients to psychiatrist. Although the serum level of lithium was within the normal therapeutic range, her daily dose of lithium was reduced to 600 mg and then stopped. 6 days after cessation of lithium, down beat nystagmus and right hypertropia were completely resolved and symptoms did not recur over a year. CONCLUSION: Even within a normal therapeutic range, downbeat nystagmus and skew deviation can occur as side effect of lithium. Dehydration may contribute to the neurotoxicity of lithium.
Subject(s)
Bipolar Disorder/drug therapy , Lithium Compounds/adverse effects , Nystagmus, Pathologic/chemically induced , Ocular Motility Disorders/chemically induced , Adult , Brain/diagnostic imaging , Diplopia/physiopathology , Female , Humans , Lithium Compounds/administration & dosage , Magnetic Resonance Imaging , Nystagmus, Pathologic/physiopathology , Ocular Motility Disorders/physiopathology , Vision, Binocular/physiologyABSTRACT
BACKGROUND: Trochleitis is trochlear pain with evidence of inflammation in the trochlear area on radiologic examination. The etiology of trochleitis is mostly idiopathic. Secondary trochleitis is rare, and trochleitis associated with paranasal sinusitis in children has not yet been reported. CASE PRESENTATION: An 8-year-old boy presented with left periorbital pain for a week. His visual acuity and eye movement were normal. There was point tenderness on palpitation over the left trochlear region without swelling or redness. Orbital magnetic resonance imaging showed focal enhancement on the left trochlea and paranasal sinusitis on the left side. The patient's symptoms and signs were completely resolved after empirical treatment for sinusitis. There was no need to inject a local steroid. CONCLUSION: Although rare, sinusitis should be considered when diagnosing and treating trochleitis in children with periorbital pain.
