[Severe atropine poisoning mimicking acute stroke]. / Intoxication grave à l'atropine mimant une urgence neurovasculaire.

INTRODUCTION: Atropine is a strong antagonist of muscarinic receptors widely used in various diseases because of its anticholinergic action. CASE-REPORT: We report here a case of accidental poisoning due to ingestion of atropine eyes drops that caused severe neurologic disorders mimicking an acute stroke. Correct diagnosis was finally made by detecting atropine in the cerebrospinal fluid of the patient. CONCLUSIONS: Atropinic poisoning can induce misleading neuropsychiatric disorders mimicking stroke. Therefore, this diagnosis should be considered in patients presenting an unexplained encephalopathy with anticholinergic manifestations, especially when bilateral mydriasis occurs.

Intoxicación por escopolamina (‘burundanga’): pérdida de la capacidad de tomar decisiones / Scopolamine poisoning ("burudanga"): loss of the ability to make decisions

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[Fever, large eyes and confusion; the anticholinergic syndrome]. / Koorts, grote ogen en verwardheid; het anticholinergisch syndroom.

A 52-year-old woman was in a confused state and had difficulty walking and swallowing, as well as dysarthria. That same day she had consumed some berries, which she thought were bilberries, but she had instead eaten Atropa belladonna (deadly nightshade). She made a spontaneous and full recovery within a few days. A 3-year-old boy, with amblyopia, was vomiting, had difficulty walking and had a temperature of 39 degrees C. He was agitated and had a warm, red skin and dilated pupils that did not respond to light. A suspected intoxication with a parasympathicolytic agent was confirmed upon an empty bottle of atropine eye drops being found at his home. The boy made a full recovery following treatment with physostigmine. It is important to consider an anticholinergenic intoxication in the case of patients who are confused, have difficulty speaking, large fixed pupils and fever. A specific anamnesis with respect to medicines, eye drops and berries or plants consumed can confirm the diagnosis. It is important to recognise an anticholinergic intoxication because without treatment, the outcome can be fatal.

Near fatal anticholinergic intoxication after routine fundoscopy.

We describe a case of severe anticholinergic intoxication following the topical instillation of tropicamide-containing eyedrops. Tropicamide is a short-acting atropine-like derivative and has been regarded as an effective and safe mydriatic. Half an hour after routine fundoscopy, a 62-year-old man experienced two generalized seizures with respiratory arrest and required intubation and mechanical ventilation. The patient was treated with physostigmine and made a full recovery.

Avoiding adverse effects of cycloplegics in infants and children.

Cycloplegics are very safe and useful medications. To avoid the unpleasant side effects of these medications, six precautions are considered. They are: 1. dosage, 2. cycloplegic selection, 3. toxic reaction, 4. biologic variations, 5. topical anesthesia, 6. environmental temperature and humidity.

Cycloplegics and mydriatics. Tolerance, habituation, and addiction to topical administration.

A patient had tolerance, habituation, and addiction to the topical use of a combination of cyclopentolate hydrochloride and tropicamide. He also developed a blotchy, diffuse epithelial keratitis that disappeared when the drugs were discontinued.