title: Blood-brain barrier disruption associated with topiramate-induced angle-closure glaucoma of acute onset.
abstract: BACKGROUND
  Topiramate (Topamax(R)) is an anti-epileptic drug of the sulfamate group used secondarily for bipolar disease.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  The presence of BBB disruption with increased protein content in CSF with simultaneous blood ocular barrier breakdown may suggest a common inflammatory mechanism.
authors.affiliation: Jules Gonin University Eye Hospital, Lausanne, Schweiz.
authors.forename: H
authors.initials: H
authors.lastname: Viet Tran
authors.forename: E
authors.initials: E
authors.lastname: Ravinet
authors.forename: C
authors.initials: C
authors.lastname: Schnyder
authors.forename: M
authors.initials: M
authors.lastname: Reichhart
authors.forename: Y
authors.initials: Y
authors.lastname: Guex-Crosier
mesh_terms: D000208:Acute Disease; D000927:Anticonvulsants / Q000009:adverse effects; D001812:Blood-Brain Barrier / Q000187:drug effects* / Q000473:pathology*; D005632:Fructose / Q000009:adverse effects / Q000031:analogs & derivatives*; D015812:Glaucoma, Angle-Closure / Q000139:chemically induced* / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009216:Myopia / Q000139:chemically induced* / Q000175:diagnosis*; D000077236:Topiramate
chemical_list: D000927:Anticonvulsants; D000077236:Topiramate; D005632:Fructose