title: [External ophthalmoplegia caused by amitriptyline poisoning].
abstract: Drug-induced ocular motor disorders occurring during coma may be difficult to distinguish from structural cerebral lesions. We recently encountered a case of reversible amitriptyline-induced external ophthalmoplegia, which was first described by Mladinich and Carlow in 1977. We suggest that the mechanism for gaze paresis and loss of vestibulo-ocular reflex due to amitriptyline overdose involves the modulation of neurons of the pontine paramedian reticular formation, the rostral fasciculus longitudinalis medialis, and the vestibulo-ocular reflex. Clinical features that might be useful when distinguishing amitriptyline-induced ophthalmoplegia from structural brain lesions--such as basilar thrombosis--include the preservation of corneal response, purposeful withdrawal from noxious stimuli, rapid recovery within 24 hours, and the reversal of symptoms by physostigmine.
authors.affiliation: Neurologische Klinik, Universität München, Klinikum Grosshadern, Marchioninistrasse 15, 81377 München.
authors.forename: S
authors.initials: S
authors.lastname: von Stuckrad-Barre
authors.forename: G
authors.initials: G
authors.lastname: Wekerle
authors.forename: T
authors.initials: T
authors.lastname: Pfefferkorn
authors.forename: M
authors.initials: M
authors.lastname: Strupp
mesh_terms: D000328:Adult; D000639:Amitriptyline / Q000506:poisoning*; D000929:Antidepressive Agents, Tricyclic / Q000506:poisoning*; D001767:Blinking / Q000187:drug effects; D003866:Depressive Disorder / Q000188:drug therapy; D003937:Diagnosis, Differential; D062787:Drug Overdose / Q000175:diagnosis*; D006801:Humans; D008297:Male; D009886:Ophthalmoplegia / Q000139:chemically induced* / Q000175:diagnosis; D012027:Reflex, Vestibulo-Ocular / Q000187:drug effects
chemical_list: D000929:Antidepressive Agents, Tricyclic; D000639:Amitriptyline