Ischemic neuropathy

Ischemic neuropathy, restlessness, and seizures are possible neurological ADRs. 

R. Ghali, et al., Erythromycin associated ergotamine intoxication Arteriographic and electrophysiologic analysis of a rare cause of severe ischemia of the lower extremities and associated in ischemic neuropathy. Ann. Vase. Surg. 7 291-296, 1993. 

Retrobulbar anesthesia, competently administered, is a safe procedure. In 13 000 patients in whom a curved needle technique was used, the only serious complication was a single case of postoperative ischemic neuropathy (296). However, other centers have experienced recurrent problems with chemosis (up to 30%), sub-conjunctival hemorrhage, and lid hemorrhage before perfecting their technique (SEDA-18, 144). 

Sequential embolization (Fig. 9.18) resulted in complete control of pain and radiographic healing of the tumors in 48% of the patients. Partial relief of symptoms was observed in an additional 19% of patients, giving a total response rate of 67% (Carrasco et al. 1990). After embolization, seven patients received chemotherapy or irradiation. One patient underwent subsequent surgery for an iliac tumor that responded to embolization. Ischemic neuropathy and a single instance of unexplained death were compKcations seen after extensive arterial embolization. 

Frequent symptoms of lower extremity arterial disease (LEAD) are pressure, tightness, squeezing sensation, burning, and frank pain precipitated by leg exercise and relieved by rest. Intermittent claudication also may be present as fatigue in working skeletal muscles. Continuous pain must be differentiated from intermittent pain, because continuous pain may be a result of a sudden arterial occlusion with or without preexisting stenosis. Extremely severe ischemia or ischemic neuropathy, ulceration, or gangrene can also cause continuous pain. 

Nonarteritic anterior ischemic optic neuropathy (NAION)... 

Some patients may experience hearing loss, which may accompany diabetes. Usually, type 2 diabetes is described in individuals with MELAS, although type 1 or insulin-dependent diabetes also may be observed. Palpitations and shortness of breath may be present in some patients with MELAS secondary to cardiac conduction abnormalities such as Wolff-Parkinson-White syndrome. Acute onset of gastrointestinal manifestations (e.g., acute onset of abdominal pain) may reflect pancreatitis, ischemic colitis, and intestinal obstruction. Numbness, tingling sensation, and pain in the extremities can be manifestations of peripheral neuropathy. Some patients may have the presentation of Leigh syndrome (i.e., subacute necrotizing encephalopathy). 

The presence of cranial neuropathy may result in a misdiagnosis of brainstem stroke. Cranial nerve palsies may result from local pressure from the false internal carotid artery lumen, thromboembolism or hemodynamic compromise to the blood supply of the nerve. Cranial nerve III receives its blood supply from the ophthalmic artery, branches of the internal carotid or the posterior cerebral artery and, consequently, may rarely become ischemic after carotid dissection. 

Relapsing polychondritis may be complicated by a generalized encephalopathy, stroke-like episodes and ischemic optic neuropathy as a result of systemic vasculitis (Stewart et al 1988 Hsu et al 2006). 

SLE is a multisystem, idiopathic, autoimmime disease characterized by infiltration of capillaries of collagen-vascular tissue by antibody-antigen complexes.The optic disc in SLE can be elevated, and there may be a painless reduction in visual acuity. SLE optic neittopathy may present as either a retrobulbar optic neittopathy or as an anterior ischemic optic neuropathy (AION). 

The causative agent in Lyme disease is a spirochetal bacterium (Borrelia burgdorferi) that is transmitted directly through the bite of a deer tick. Optic neittopathy can occur due to Lyme disease and manifests as papillitis, retrobulbar neuropathy, or ischemic optic neiu-opathy. Serologic testing may help to identify Lyme infection by use of indirect immunofluorescent assay and enzyme-linked immunosorbent assay.The treatment of Lyme disease includes oral or intravenous peniciUin, doxycycUne, erythromycin, or ceftriaxone. 

The Ischemic Optic Neuropathy Decompression Trial Research Group. Optic nerve decompression surgery for non-arteritic arteriole ischemic optic neuropathy (AION) is not effective and may be harmful. JAMA 1995 273 625-632. 

Dittereatial Diagnosis. Differential diagnoses of disc hemorrhages include posterior vitreous detachment, diabetic retinopathy, hypertensive retinopathy, hemorrhage resulting from optic disc drusen, ischemic optic neuropathy, leukemia, and peripapillary neovascular membrane. 

Patients should receive a baseline ophthalmic examination before starting therapy with amiodarone and every 6 months thereafter. Amiodarone should be promptly discontinued in the event of optic neuropathy, as long as reasonable medical alternatives exist. These issues must be considered in consultation with the patient s cardiologist or internist. Other recommendations have suggested that if simultaneous bilateral disc edema presents and tests are negative for arteritic ischemic optic neuropathy and increased intracranial pressure, the drug should be discontinued. However, if imilateral typical NAION occurs in a crowded disc and no other sign of systemic toxicity to amiodarone is noted, then continuation of amiodarone may be considered. 

Hayreh SS. Erectile dysfunction drugs and non-arteritic anterior ischemic optic neuropathy is there a cause and effect relationship J Neuroophthaknol 2005 25 295-298. 

Possible" effects (all possibly due to the associated activity and not the drug) mydriasis, retinal vascular accidents, subconjunctival hemorrhages, anterior ischemic optic neuropathy (NAION), central serous chorioretinopathy (CSCR)... 

Note OADRs = ocular adverse drug reactions CV = color vision VF = visual field VL = vision loss NFL = nerve fiber layer lOP = intraocular pressure NSAIDs = nonsteroidal anti-inflammatory drugs TBUT = tear break-up time CL = contact lens IH = intracranial hypertension RD = retinal detachment NAION = nonarteritic ischemic optic neuropathy. 

Several disorders may mimic glaucomatous ONH and/or visual field changes. Those that resemble structural glaucomatous optic neuropathy or interfere wdth assessment of glaucomatous cupping include optic disc anomalies, tilted discs, optic nerve drusen, optic nerve pits, optic nerve colobomas, myelinated nerve fibers, ischemic optic neuropathy and optic atrophy. 

Bilateral ischemic optic neuropathy can develop secondary to acute ergotism after administration of ergotamine tartrate (25). 

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