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[External ophthalmoplegia caused by amitriptyline poisoning]
S von Stuckrad-Barre1, G Wekerle, T Pfefferkorn
1Neurologische Klinik, Universität München, Klinikum Grosshadern, Marchioninistrasse 15, 81377 München.
Der Nervenarzt
|April 27, 2002
Summary
Amitriptyline overdose can cause reversible external ophthalmoplegia, a condition affecting eye movements during coma. Key indicators include preserved corneal response and rapid recovery, distinguishing it from brain lesions.
Area of Science:
- Neuroscience
- Ophthalmology
- Clinical Toxicology
Background:
- Distinguishing drug-induced ocular motor disorders from structural brain lesions during coma is clinically challenging.
- Amitriptyline-induced external ophthalmoplegia is a rare, reversible condition previously described in medical literature.
Observation:
- A case of reversible amitriptyline-induced external ophthalmoplegia during coma was observed.
- The patient presented with ophthalmoplegia, a disorder affecting eye muscle control.
Findings:
- Amitriptyline overdose likely impairs gaze control by affecting pontine paramedian reticular formation and medial longitudinal fasciculus.
- The vestibulo-ocular reflex is also modulated, leading to eye movement abnormalities.
Implications:
- Clinical features like preserved corneal response and rapid recovery (within 24 hours) can help differentiate amitriptyline-induced ophthalmoplegia from structural lesions.
- Physostigmine may reverse the symptoms of amitriptyline-induced ophthalmoplegia, offering a potential treatment strategy.