[External ophthalmoplegia caused by amitriptyline poisoning].
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.
von Stuckrad-Barre
S
S
Neurologische Klinik, Universität München, Klinikum Grosshadern, Marchioninistrasse 15, 81377 München.
Wekerle
G
G
Pfefferkorn
T
T
Strupp
M
M
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
D000929:Antidepressive Agents, Tricyclic; D000639:Amitriptyline