Nystagmus

Other agents are also used for the treatment of manic-depressive disorders based on preliminary clinical results (177). The antiepileptic carbamazepine [298-46-4] has been reported in some clinical studies to be therapeutically beneficial in mild-to-moderate manic depression. Carbamazepine treatment is used especially in bipolar patients intolerant to lithium or nonresponders. A majority of Hthium-resistant, rapidly cycling manic-depressive patients were reported in one study to improve on carbamazepine (178). Carbamazepine blocks noradrenaline reuptake and inhibits noradrenaline exocytosis. The main adverse events are those found commonly with antiepileptics, ie, vigilance problems, nystagmus, ataxia, and anemia, in addition to nausea, diarrhea, or constipation. Carbamazepine can be used in combination with lithium. Several clinical studies report that the calcium channel blocker verapamil [52-53-9] registered for angina pectoris and supraventricular arrhythmias, may also be effective in the treatment of acute mania. Its use as a mood stabilizer may be unrelated to its calcium-blocking properties. Verapamil also decreases the activity of several neurotransmitters. Severe manic depression is often treated with antipsychotics or benzodiazepine anxiolytics. 

Wernicke s syndrome is a serious consequence of alcoholism and thiamine (vitamin Bx) deficiency. Certain characteristic signs of this disease, notably ophtalmoplegia, nystagmus, and ataxia, respond rapidly to the administration of thiamine but to no other-vitamin. Wernicke s syndrome may be accompanied by an acute global confusional state that may also respond to thiamine. Left untreated, Wernicke s syndrome frequently leads to a chronic disorder in which learning and memory are strongly impaired. This so-called Korsakoff s psychosis is characterized by confabulation, and is less likely to be reversible once established. 

Sedated, drowsy, slurred speech, nystagmus, ataxia, positive Romberg test result 500-600 150-200... 

Few signs of intoxication, patient is comfortable, may have lateral nystagmus 800 250... 

Neurological signs nystagmus, miosis, blurred vision, tremor, slurred speech, dystonia, convulsion, amnesia, confusion, peripheral numbness... 

Severe Delirium with auditory or visual hallucinations and confusion, delusional thinking, autonomic instability with hypertension, increased temperature, severe agitation, horizontal nystagmus... 

FIGURE 4.2 Seventy-three-year-old female with sudden right hemiparesis, left facial weakness, dysarthria, nausea, and downheat nystagmus. Posterior circulation angioplasty demonstrated occlusion of the proximal hasilar artery (arrows— a and b). Note the retrograde opacification of the superior cerebellar arteries through postero-inferior cerebellar to superior cerebellar arteries collaterals (b). 

Kylin B, Axell K, Samuel HE, et al. 1967. Effect of inhaled trichloroethylene on the CNS as measured by optokinetic nystagmus. Arch Environ Health 15 48-52. 

PCP affects the sensorium, behavior, and vital signs, and it may affect motor and autonomic functions. Hypertension and nystagmus... 

Any of the motor or autonomic signs, and hypertension and/or nystagmus may occur with any of the minor PCP patterns. Minor patterns should not be diagnosed on physical examination in an emergency department without adequate information about the patient s behavior and sensoriurn prior to admission. Many patients with major patterns may be alert and oriented when they reach the hospital. If no history is available, the patient is kept under observation and rhabdomyolysis is ruled out. 

Eye movements were noted to be deviant in 25 percent of the infants during the neonatal period. Nystagmus and darting eye movements were seen. Also, a glazed stare associated with total body stillness was frequently seen during the first 6 weeks. 

McCarron s paper (this volume) describes the behaviors of 1,000 adults admitted to an inpatient service with acute symptoms of PCP intoxication. She states that some of the patients have appropriate behavior while many have mute and staring episodes, bizarre facial grimacing, localized dystonic reactions, rigidity, tremors, coarse jerky movements, and nystagmus. Thus, there is similarity between the acutely intoxicated adult s behavior and that of the newborn with a positive urine toxic screen for PCP. 

Patients with SE usually present with generalized, convulsive tonic-clonic seizure activity that is unresponsive to initial AED treatment. They may also be hypertensive, tachycardic, febrile, and diaphoretic however, these symptoms will resolve soon after the seizure is terminated. A loss of bowel or bladder function, respiratory compromise, and nystagmus may also... 

HEENT Scleral icterus, dry mucous membranes, pinpoint pupils, dilated and fixed pupils, nystagmus... 

HDAC toxicides cerebellar direct neurotoxicity ataxia, slurred speech, nystagmus conjunctivitis (drug is excreted into tears and blocks corneal DNA synthesis)... 

Instruct patients receiving phenytoin about the symptoms of elevated serum concentrations (e.g., nystagmus, blurred vision, dizziness, drowsiness, and lethargy). 

Phenytoin Nystagmus, gingival hyperplasia, ataxia, hirsutism... 

The answer is g. (KatzungT pp 399-400J Phenytoin is one of the most commonly used antiepileptic agents. Chronic administration has been reported to cause adverse reactions, such as ataxia, dizziness, nystagmus, gingival hyperplasia, hirsutism, and megaloblastic anemia. 

Signs and Symptoms Causes abortions, stillbirths and fetal deformities including blindness, nystagmus, deafness, dullness, incoordination, and/or paralysis. 

Friedreich s ataxia is caused by an intronic triplet repeat expansion. Friedreich s ataxia is an autosomal recessive disorder characterized by progressive ataxia, nystagmus, distal sensory polyneuropathy and corticospinal tract degeneration. It is caused by an unstable expanded GAA repeat in intron 1 of the frataxin gene on chromosome 9ql3. This diminishes expression of frataxin, a mitochondrial iron-storage protein that participates in free radical metabolism [71]. 

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