ABSTRACT
No disponible
Subject(s)
Humans , Female , Adult , Muscle Cramp/chemically induced , Sumatriptan/adverse effects , Migraine Disorders/chemically induced , Sumatriptan/administration & dosage , Serotonin Receptor Agonists/adverse effects , Drug ToleranceABSTRACT
INTRODUCTION: We report a patient who developed an acute confusional state with hallucinations after exposure to cycloplejic eye drops, and review the current literature regarding neurotoxicity due to this type of eye drops. CASE REPORT: A 61 year-old man who developed in two occasions confusion, disorientation and vivid visual hallucinations following exposure to a cyclopejic eye drop containing atropine 2%, scopolamine 0.5% and phenylephrine 4%. We performed a literature search regarding neurological complications of cycloplegic eye drops using the PubMed Database and the services of the Virtual Library 'Agencia Lain Entralgo'. The clinical features of all reports in which the original document was obtained are analyzed and summarized. We have summarized the clinical features of 29 patients with neurotoxicity due to cyclopentolate, 19 to atropine, 18 to scopolamine, 7 to homatropine, and 2 to tropicamide. Our patient should be the fourth reported in Spain, being the offending drug in the four cases the same eye drop. The most commonly reported symptoms are visual hallucinations, behavioral disorders/acute psychosis, alterations of consciousness/confusion, restlessness/hyperactivity, ataxia and speech disorders. Many of the patients reported are children and elder. There have been reported some fatal cases, specially related with atropine. CONCLUSIONS: Neurotoxicity related with anticholinergic effects of cycloplegic agents is not infrequent, although it is not well known in our setting; and can cause death in some cases. Exposure to these drugs should be taken in account in the differential diagnosis of acute confusional syndromes.
Subject(s)
Mydriatics/adverse effects , Neurotoxicity Syndromes/etiology , Administration, Topical , Humans , Male , Middle Aged , Mydriatics/administration & dosageABSTRACT
Introducción. Se describe el caso de un paciente que presentóun cuadro confusional agudo con alucinaciones visuales trasla exposición a un colirio ciclopléjico y se revisa además la bibliografíaexistente con respecto a esta complicación del uso de dichotipo de colirios. Caso clínico. Varón de 61 años que sufrió en dosocasiones un cuadro de confusión, desorientación temporoespacialy alucinaciones visuales vívidas tras exposición a un colirio ciclopléjicoque contenía atropina al 2%, escopolamina al 0,5% y fenilefrinaal 4%. Se realizó una búsqueda bibliográfica de complicacionesneurológicas de los colirios ciclopléjicos utilizando las basesde datos PubMed y los servicios de la Biblioteca Virtual de laAgencia Laín Entralgo. Se analizan los datos clínicos de todasaquellas publicaciones en las que se tuvo acceso al documento original.Hemos documentado los datos clínicos correspondientes a29 casos debidos a ciclopentolato, 19 a atropina, 18 a escopolamina,7 a homatropina y 2 a tropicamida. Nuestro caso sería el cuartoregistrado en España; en todos éstos es responsable el mismotipo de colirio. Los síntomas que se han descrito con mayor frecuenciason alucinaciones visuales, trastornos de conducta/psicosisaguda, alteración de nivel de conciencia/confusión, inquietudmotora/hiperactividad, ataxia/incoordinación motora y alteracionesdel lenguaje. La mayoría de los casos publicados correspondea niños y ancianos. En algunas ocasiones se ha descrito mortalidad,especialmente relacionada con atropina. Conclusiones. Laneurotoxicidad debida al efecto anticolinérgico de los agentes ciclopléjicosno es infrecuente, si bien es poco conocida en nuestromedio; puede llegar a causar la muerte. La exposición a dichos fármacosdebe tenerse en cuenta en el diagnóstico diferencial de loscuadros confusionales
Introduction. We report a patient who developed an acute confusional state with hallucinations after exposure tocycloplejic eye drops, and review the current literature regarding neurotoxicity due to this type of eye drops. Case report. A 61year-old man who developed in two occasions confusion, disorientation and vivid visual hallucinations following exposure toa cyclopejic eye drop containing atropine 2%, scopolamine 0.5% and phenylephrine 4%. We performed a literature searchregarding neurological complications of cycloplegic eye drops using the PubMed Database and the services of the VirtualLibrary Agencia Laín Entralgo. The clinical features of all reports in which the original document was obtained areanalyzed and summarized. We have summarized the clinical features of 29 patients with neurotoxicity due to cyclopentolate,19 to atropine, 18 to scopolamine, 7 to homatropine, and 2 to tropicamide. Our patient should be the fourth reported in Spain,being the offending drug in the four cases the same eye drop. The most commonly reported symptoms are visual hallucinations,behavioral disorders/acute psychosis, alterations of consciousness/confusion, restlessness/hyperactivity, ataxia and speechdisorders. Many of the patients reported are children and elder. There have been reported some fatal cases, specially relatedwith atropine. Conclusions. Neurotoxicity related with anticholinergic effects of cycloplegic agents is not infrequent, althoughit is not well known in our setting; and can cause death in some cases. Exposure to these drugs should be taken in account inthe differential diagnosis of acute confusional syndromes
Subject(s)
Male , Middle Aged , Humans , Psychoses, Substance-Induced , Hallucinations/chemically induced , Scopolamine/adverse effects , Phenylephrine/adverse effects , Ophthalmic Solutions , Atropine/administration & dosage , Atropine/adverse effects , Diagnosis, DifferentialABSTRACT
No disponible
No disponible
Subject(s)
Male , Aged , Humans , Baclofen/administration & dosage , Baclofen/adverse effects , Baclofen/therapeutic use , Coma/chemically induced , Muscle Relaxants, Central/administration & dosage , Muscle Relaxants, Central/adverse effects , Muscle Relaxants, Central/therapeutic use , Drug Overdose , Infusion Pumps, Implantable , Injections, Spinal , Muscle Spasticity/drug therapySubject(s)
Baclofen , Coma/chemically induced , Drug Overdose , Muscle Relaxants, Central , Aged, 80 and over , Baclofen/administration & dosage , Baclofen/adverse effects , Baclofen/therapeutic use , Humans , Infusion Pumps, Implantable , Injections, Spinal , Male , Muscle Relaxants, Central/administration & dosage , Muscle Relaxants, Central/adverse effects , Muscle Relaxants, Central/therapeutic use , Muscle Spasticity/drug therapyABSTRACT
8 cases of syringomyelic arthropathy which were detected in 6 patients of 13 afflicted of syringomyelia, are presented. The etiopathogenesis, clinical, radiological, and pathological data are commented on; and an eclectic mechanism which mixed the 3 theories admitted: neurotrophic, neurotraumatic, and neurovascular, is suggested. We found the incidence of arthropathy higher than that described in existing medical literature and concluded that it is necessary to perform wide administer the appropriate therapy.
Subject(s)
Joint Diseases/etiology , Syringomyelia/complications , Arthropathy, Neurogenic/diagnostic imaging , Arthropathy, Neurogenic/epidemiology , Arthropathy, Neurogenic/etiology , Humans , Incidence , Joint Diseases/diagnostic imaging , Joint Diseases/epidemiology , Radiography , Syringomyelia/diagnostic imaging , Syringomyelia/epidemiologyABSTRACT
The nerve action potential at the elbow and somatosensory evoked potentials (SEPs) at the scalp were recorded over 30 minutes of tourniquet-induced limb ischaemia in 10 diabetic patients and 10 controls. According to the SEP changes, an increased resistance to nerve ischaemia in diabetic patients was observed. The pathways involved in SEP conduction are discussed.
