Related Experiment Videos
Blood-brain barrier disruption associated with topiramate-induced angle-closure glaucoma of acute onset
H Viet Tran1, E Ravinet, C Schnyder
1Jules Gonin University Eye Hospital, Lausanne, Schweiz.
Background:
Topiramate (Topamax(R)) is an anti-epileptic drug of the sulfamate group used secondarily for bipolar disease.
History And Signs:
One week after initiation of topiramate treatment for a bipolar disorder, a 57-year-old man presented with blurred vision. Clinical examination revealed a bilateral conjunctivitis, areflexic mydriasis, severe anterior chamber shallowing, with a myopic shift and vitritis.
Therapy And Outcome:
A spinal tap revealed an increased protein content of 1581 mg/L on cerebrospinal fluid (CSF) analysis, being compatible with a rupture of the blood-brain barrier (BBB). UBM exposed bilateral ciliochoroidal effusions with secondary angle-closure. Topiramate was promptly discontinued, whereas visual acuity, intraocular pressure (IOP), and anterior and posterior segments anatomy normalized within 1 week. One month later, bilateral iris atrophy was present.
Conclusion:
The presence of BBB disruption with increased protein content in CSF with simultaneous blood ocular barrier breakdown may suggest a common inflammatory mechanism.
Related Concept Videos
Angle Closure Glaucoma: Treatment
Open Angle Glaucoma: Treatment
Drugs such as carbonic anhydrase inhibitors, α2- and...
Glaucoma: Overview
Cerebral Edema ll: Pathophysiology
The Blood-brain Barrier
Increased Intracranial Pressure ll: Pathophysiology