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[Coma with bilateral mydriasis after use of transdermal scopolamine in ICU]

X Repéssé1, T Geeraerts, J Pottecher

  • 1Département d'anesthésie-réanimation chirurgicale, hôpital de Bicêtre, APHP, faculté de médecine, université Paris-Sud, 94275 Le Kremlin-Bicêtre, France.

Annales Francaises D'Anesthesie Et De Reanimation
|October 27, 2007
PubMed

Insights

Transdermal scopolamine can cause central anticholinergic syndrome in ICU patients, leading to coma and dilated pupils. Prompt removal of the medication rapidly reversed these neurological symptoms.

Area of Science:

  • Neurology
  • Critical Care Medicine
  • Pharmacology

Background:

  • A patient with a history of head trauma and hydrocephalus requiring ventricular derivation was admitted to the ICU.
  • The patient presented with a coma (Glasgow Coma Score=8) and bilateral mydriasis.

Observation:

  • The neurological deterioration occurred after the administration of transdermal scopolamine (1 mg) to manage profuse bronchial secretions.
  • Neurological investigations, including CT-scan and electroencephalogram, ruled out organic causes for the patient's condition.

Findings:

  • The patient's neurological status rapidly and completely improved upon discontinuation of transdermal scopolamine.
  • These findings strongly suggest a diagnosis of central anticholinergic syndrome.

Implications:

  • This case highlights the potential for transdermal scopolamine to induce severe anticholinergic effects in critically ill patients.
  • Clinicians should consider central anticholinergic syndrome in the differential diagnosis of unexplained neurological deterioration in patients using scopolamine.
  • Early recognition and removal of the offending agent are crucial for rapid recovery.

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