1/20. Blurred vision, left bundle-branch block and cardiac failure.We cared for a patient with progressive renal impairment who presented with blurred vision, QRS broadening and cardiac failure due to chronic cibenzoline intoxication.Treatment consisted of catecholamines and repetitive infusions of Ringer lactate. Cardiac function and symptoms recovered completely.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
2/20. Visual symptoms after lung transplantation: a case of progressive multifocal leukoencephalopathy.After solid organ transplantation, signs and symptoms of the central nervous system may present a diagnostic challenge. A 43-year-old patient developed a decrease in vision 15 months after bilateral lung transplantation. The initial diagnosis was a left posterior cataract, but left eye cataract extraction did not improve his vision. seizures led to investigation of a broader differential diagnosis (cyclosporine intoxication, post-transplant lymphoproliferative disorder, infectious disease, chronic lymphatic leukemia). The clinical diagnosis of progressive multifocal leukoencephalopathy (PML) was confirmed by demonstration of jc virus in the cerebrospinal fluid and by autopsy findings. Modulation of the immunosuppressive regimen was unsuccessful. This case illustrates that decreased vision in immunocompromised patients may be the first manifestation of PML.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
3/20. Unexplained drowsiness and progressive visual loss: methanol poisoning diagnosed at autopsy.A patient was admitted to the emergency department with a reduced level of consciousness and deteriorating vision. Her pupils became fixed and dilated and she developed a third nerve palsy with extensor posturing of her limbs. biochemistry profile showed an increased serum osmolar gap with a raised anion gap metabolic acidosis. Supportive treatment was instituted, but she made no recovery and brainstem death was later confirmed. Post mortem examination and toxicology screen confirmed the cause of death as methanol poisoning leading to cerebral oedema and transtentorial herniation. We highlight some of the diagnostic difficulties associated with treating a patient with a reduced level of consciousness. The clinical and biochemical findings that are critical in establishing a diagnosis of methanol intoxication are discussed. The definitive management of methanol poisoning is reviewed.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
4/20. hydrogen peroxide neurotoxicity in childhood: case report with unique magnetic resonance imaging features.Concentrated hydrogen peroxide (H2O2) intoxication is relatively rare in children. Serious irreversible neurotoxicity generally results. The case of an 11-year-old boy who inadvertently drank a concentrated (35%) H2O2 solution is described. He exhibited signs of an acute encephalopathy with cortical visual impairment. Extensive cerebrocortical diffusion restriction with apparent gyral edema was evident at 3 days following ingestion, particularly in the parieto-occipital regions bilaterally. Spontaneous neurologic improvement quickly followed, and nearly full clinical resolution was evident 1 month later. The pattern of imaging abnormalities closely resembles that of reversible posterior leukoencephalopathy. Concentrated H2O2 neurotoxicity in children can exhibit unique patterns (a reversible posterior leukoencephalopathy) and a better than expected outcome.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
5/20. A child with elemental mercury poisoning and unusual brain MRI findings.Mercury vapor poisoning is a serious and potentially fatal problem. Neurological manifestations involving the central nervous system are seen with chronic mercury intoxication. We present the case of a 10-year-old child who demonstrated acrodynia, seizures, and visual impairment following 20 days of exposure to elemental mercury at home. The initial blood mercury concentration was 27.7 microg/L (normal <2 microg/L) and the initial 24-hour urine mercury concentration was 34.4 microg/L (normal =10 microg/L). After 9 months of treatment with D-penicillamine, the patient's clinical condition, biochemical laboratory parameters, and mercury concentrations all returned to normal. The T2-weighted MRI images of the patient's brain initially showed multiple hyperintense lesions in cerebral white matter, left globus pallidus, and putamen, which also improved.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
6/20. 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) |
7/20. methanol intoxication. Parkinsonism and decreased Met-enkephalin levels due to putaminal necrosis.Due to methanol intoxication, a 38-year-old male developed permanent parkinsonism with visual impairment. brain computerized tomography (CT) and magnetic resonance imaging (MRI) revealed cystic resorption of the putamen. An alteration of the central noradrenergic activity and the opioid system can be assumed because of increased dopamine beta-hydroxylase (D beta H) activity and decreased methionine-enkephalin (Met-Enk) levels in the cerebrospinal fluid (CSF).- - - - - - - - - - ranking = 5keywords = intoxication (Clic here for more details about this article) |
8/20. Visual loss and intoxication.The Foster Kennedy syndrome is very uncommon. The literature cited is often confusing. This paper presents a lucid definition of the syndrome that has contemporary diagnostic value and tenacious historical roots. We attempt to "sort-out" the true Foster Kennedy syndrome from its congeners and discuss the misnomers involved. An illustrative case is presented.- - - - - - - - - - ranking = 4keywords = intoxication (Clic here for more details about this article) |
9/20. 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) |
10/20. color vision deficiencies in two cases of digoxin toxicity.color vision deficiencies are a common sign of digoxin intoxication and color vision testing can be used to diagnose digoxin toxicity. We tested two patients, a 79-year-old man and a 61-year-old man, with digoxin toxicity by means of the Farnsworth-Munsell 100-hue test, AOH-R-R plates, and Ishihara plates. Initial testing disclosed both red-green and blue-yellow color vision deficiencies. These improved when digoxin levels diminished. The deficiencies were superimposed on preexisting acquired and congenital deficits. As serum digoxin levels decreased, the color vision deficiencies lessened on all three tests. The Farnsworth-Munsell 100-hue test gave the best quantifiable measure of color vision deficiencies, but proved difficult to use for routine bedside testing.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
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