1/9. Bialaphos poisoning with apnea and metabolic acidosis.A 64-year-old man with ethanol intoxication, ingested a bottle of Herbiace (100 ml, 32 w/v% of bialaphos, CAS #35597-43-4, Meiji Seika Kaisha, tokyo, japan). He had severe metabolic acidosis and was treated with infusions of sodium bicarbonate and furosemide, plus gastric lavage and enema. The metabolic acidosis improved 15 hours after treatment but nystagmus, apnea and convulsions were progressive. Although his sensorium was clear, spontaneous respirations were not observed for 64 hours. The electroencephalographic findings of atypical triphasic waves and slow waves suggest a unique response to bialaphos poisoning. His clinical course indicates that the management of apnea is critically important to recovery from bialaphos poisoning.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
2/9. Lithium-induced downbeat nystagmus.We examined six patients who developed blurring or oscillopsia as a result of downbeat nystagmus while being treated with lithium carbonate. Of these six plus six previously described similar patients, all but two developed downbeat nystagmus insidiously as an isolated disorder in the setting of otherwise satisfactory therapeutic control, without clinical or biochemical evidence of acute lithium intoxication. Only six of these 12 patients were able either to reduce or to stop taking lithium, and in only two of these six did the downbeat nystagmus improve or remit.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
3/9. Reversible downbeat nystagmus secondary to excessive alcohol intake.Three patients are reported who presented with primary position downbeat nystagmus without any other evidence of cerebellar dysfunction. After 2 weeks of abstinence from alcohol, the downbeat nystagmus resolved totally in two cases, and could be elicited only with head hanging in the third. Radiologic evaluation, including computed tomographic (CT) scan of the posterior fossa and craniocervical junction, were normal in each case. These are the first cases reported of reversible downbeat nystagmus secondary to alcohol intake. They suggest that a patient with downbeat nystagmus and a history of recent significant alcohol intoxication should be observed for resolution of this sign after a period of abstinence before extensive radiologic evaluation is undertaken.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
4/9. A case of lithium intoxication with downbeat vertical nystagmus.lithium carbonate has recently been used in the treatment of manic diseases. However, since the marginal range between therapeutic and toxic doses is very narrow, close attention should be paid to the development of adverse reactions in its application. Lithium intoxication is manifested by neurological symptoms. Neurotological tests were performed on a patient with lithium intoxication that occurred in the course of psychiatric treatment of mania. The observed sequelae included marked downbeat vertical nystagmus and truncal ataxia. The main lesions in the present case were considered to be located in the cerebellum. Close observation, including neurotological tests, is of greatest importance because in cases of lithium intoxication the development of cerebellar as well as brainstem disorders must not be overlooked.- - - - - - - - - - ranking = 7keywords = intoxication (Clic here for more details about this article) |
5/9. Two cases of downbeat nystagmus and oscillopsia associated with carbamazepine.Downbeat nystagmus is often associated with structural lesions at the craniocervical junction, but has occasionally been reported as a manifestation of metabolic imbalance or drug intoxication. We recorded the eye movements of two patients with reversible downbeat nystagmus related to carbamazepine therapy. The nystagmus of both patients resolved after reduction of the serum carbamazepine levels. Neuroradiologic investigations including magnetic resonance imaging scans in both patients showed no evidence of intracranial abnormality. In patients with downbeat nystagmus who are taking anticonvulsant medications, consideration should be given to reduction in dose before further investigation is undertaken.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
6/9. Downbeat nystagmus with phenytoin.Downbeat nystagmus is generally the result of a structural lesion at the craniocervical junction. It has rarely been reported as a manifestation of metabolic disease or drug intoxication. We observed two patients with downbeat nystagmus secondary to phenytoin (Dilantin) intoxication. Both individuals had other features of phenytoin-induced central nervous system dysfunction with toxic blood levels of the drug (greater than 20 micrograms/ml). Complete resolution of the downbeat nystagmus followed the return of phenytoin levels to the therapeutic range.- - - - - - - - - - ranking = 2keywords = intoxication (Clic here for more details about this article) |
7/9. Periodic alternating nystagmus in phenytoin intoxication.A patient with alcoholic cerebellar degeneration had periodic alternating nystagmus during a period of phenytoin intoxication. The nystagmus resolved as the serum phenytoin level fell, as demonstrated by electronystagmography. Periodic alternating nystagmus generally implies structural brainstem disease, especially at the craniocervical junction. To our knowledge, its drug-related occurrence has not been previously reported.- - - - - - - - - - ranking = 5keywords = intoxication (Clic here for more details about this article) |
8/9. Upbeating nystagmus resulting from anticonvulsant intoxication. Report of a case.A rare case of upbeating nystagmus, which occurred under the condition of a loss of visual fixation, due to anticonvulsant intoxication is reported. This patient, a 29 year old male, suffered from grand mal epilepsy for about 12 years, and he had been treated with anticonvulsive drugs. Although a neurological evaluation by a neurosurgeon could suggest the presence of a vague cerebellar sign, neuro-otological evaluation disclosed diverse abnormal findings which clearly demonstrated the presence of dysfunction in the cerebellar system, especially of the verminal and flocculonodular lobe lesion. This may indicate that the anticonvulsive drug affected the vermis and flocculonodular lobe much more than the hemisphere of cerebellum, or that the cerebellar system sign in verminal and flocculonodular lobe lesion and its connection is detected more easily than the hemispheric lesion with the aid of a neuro-otological examination. It was presumed that the upbeating nystagmus in this case was elicited from the lesion of the anterior vermis of the cerebellum and/or its connections. Usefulness and sensitivity of the neuro-otological examination in the field of dysequilibrium of central disorder as well as peripheral vestibular disorder is emphasized.- - - - - - - - - - ranking = 5keywords = intoxication (Clic here for more details about this article) |
9/9. phenytoin toxicity from smoking crack cocaine adulterated with phenytoin.Drugs of abuse often are adulterated with agents designed to lower cost or alter the intoxication. Recently, we began to hear of the intentional addition of phenytoin to crack cocaine. We report the cases of five patients with measurable phenytoin levels attributable to smoking crack cocaine adulterated with phenytoin. Three of these patients presented with signs, symptoms, and phenytoin levels consistent with phenytoin toxicity. Clinicians should be aware of this practice when faced with cocaine users with altered mental status, ataxia, or nystagmus.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |