Neuro-ophthalmologic side-effects of systemic medications

Pula, John H.; Kao, Angela M.; Kattah, Jorge C.

doi:10.1097/01.icu.0000434557.30065.a7

Cited by 11 publications

(5 citation statements)

References 61 publications

(38 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[ 1 ] In addition, subclinical MG may become apparent after treatment for other disorders. Finally, some medications potentially induce the new onset of MG. [ 2 ] Recently, drug-related MG has received special attention because of immune-related autoimmune events after treatment with immune checkpoint inhibitors (ICIs). [ 3 – 7 ]…”

Section: Introductionmentioning

confidence: 99%

New onset of myasthenia gravis after intravesical Bacillus Calmette-Guerin

Takizawa

Kojima²,

Suzuki³

et al. 2017

Medicine

View full text Add to dashboard Cite

Rationale:Recently, drug-related myasthenia gravis (MG) has received attention, because the number of reported cases involving MG associated with immune checkpoint inhibitors, a new immunotherapy, is increasing. We present a case involving the new onset of MG, in which the symptoms started shortly after intravesical Bacillus Calmette-Guerin (BCG) for bladder cancer.Patient concerns:A 69-year-old male with bladder cancer developed ptosis and diplopia 4 days after the completion of a treatment regimen with intravesical BCG weekly for 6 weeks.Diagnoses:Ocular MG was confirmed by a positive serum anti-acetylcholine receptor antibody test.Interventions:Treatment with high-dose methylprednisolone pulse therapy was given, after insufficient treatment with pyridostigmine bromide and 10 mg/d prednisolone.Outcomes:Symptoms resolved completely 12 days after high-dose methylprednisolone pulse therapy.Lessons:Intravesical BCG could be listed as a novel drug that may induce a new onset of MG along with drugs such as D-penicillamine and immune checkpoint inhibitors.

show abstract

Section: Introductionmentioning

confidence: 99%

New onset of myasthenia gravis after intravesical Bacillus Calmette-Guerin

Takizawa

Kojima²,

Suzuki³

et al. 2017

Medicine

View full text Add to dashboard Cite

show abstract

“…Trifluoperazine has been previously reported to cause retinal pigmentary changes and accommodative deficits as ophthalmological side effects that were unobserved in the current report. 5 8 …”

Section: Discussionmentioning

confidence: 99%

An Unusual Occurrence of Trifluoperazine-Induced Nystagmus in Persistent Hallucinatory Disorder—A Case Report

Muthuramalingam

Chandrasekaran

Subramanian

2020

JNRP

View full text Add to dashboard Cite

Trifluoperazine is a conventional antipsychotic whose use has been limited with the arrival of relatively new atypical antipsychotics. However, conventional antipsychotics are utilized in the management of psychiatric illnesses comorbid with metabolic disorders such as diabetes or dyslipidemia. Though trifluoperazine has been known to cause extrapyramidal symptoms, rarely ophthalmic symptoms manifest. Here, we discuss the rare occurrence of newly-emergent nystagmus in an individual with persistent hallucinatory disorder and comorbid diabetes mellitus treated with trifluoperazine.

show abstract

“…The pupillary light response is less susceptible to confounding and may be assessed 72 h from ROSC, conditional on the absence of hypothermia or other potential confounders at the time of assessment. The most common potential confounders include medications such as mydriatic ophthalmic drops and nebulized bronchodilators [70] and prior ophthalmic surgery. Sedatives and neuromuscular blockade used at moderate therapeutic doses do not typically abolish this response [71][72][73][74].…”

Section: Questionmentioning

confidence: 99%

Guidelines for Neuroprognostication in Comatose Adult Survivors of Cardiac Arrest

et al. 2023

View full text Add to dashboard Cite

Background Among cardiac arrest survivors, about half remain comatose 72 h following return of spontaneous circulation (ROSC). Prognostication of poor neurological outcome in this population may result in withdrawal of life-sustaining therapy and death. The objective of this article is to provide recommendations on the reliability of select clinical predictors that serve as the basis of neuroprognostication and provide guidance to clinicians counseling surrogates of comatose cardiac arrest survivors. Methods A narrative systematic review was completed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Candidate predictors, which included clinical variables and prediction models, were selected based on clinical relevance and the presence of an appropriate body of evidence. The Population, Intervention, Comparator, Outcome, Timing, Setting (PICOTS) question was framed as follows: “When counseling surrogates of comatose adult survivors of cardiac arrest, should [predictor, with time of assessment if appropriate] be considered a reliable predictor of poor functional outcome assessed at 3 months or later?” Additional full-text screening criteria were used to exclude small and lower-quality studies. Following construction of the evidence profile and summary of findings, recommendations were based on four GRADE criteria: quality of evidence, balance of desirable and undesirable consequences, values and preferences, and resource use. In addition, good practice recommendations addressed essential principles of neuroprognostication that could not be framed in PICOTS format. Results Eleven candidate clinical variables and three prediction models were selected based on clinical relevance and the presence of an appropriate body of literature. A total of 72 articles met our eligibility criteria to guide recommendations. Good practice recommendations include waiting 72 h following ROSC/rewarming prior to neuroprognostication, avoiding sedation or other confounders, the use of multimodal assessment, and an extended period of observation for awakening in patients with an indeterminate prognosis, if consistent with goals of care. The bilateral absence of pupillary light response > 72 h from ROSC and the bilateral absence of N20 response on somatosensory evoked potential testing were identified as reliable predictors. Computed tomography or magnetic resonance imaging of the brain > 48 h from ROSC and electroencephalography > 72 h from ROSC were identified as moderately reliable predictors. Conclusions These guidelines provide recommendations on the reliability of predictors of poor outcome in the context of counseling surrogates of comatose survivors of cardiac arrest and suggest broad principles of neuroprognostication. Few predictors were considered reliable or moderately reliable based on the available body of evidence.

show abstract

Neuro-ophthalmologic side-effects of systemic medications

Abstract: This review discusses neuro-ophthalmological problems and the medications that may precipitate them.

Cited by 11 publications

References 61 publications

New onset of myasthenia gravis after intravesical Bacillus Calmette-Guerin

New onset of myasthenia gravis after intravesical Bacillus Calmette-Guerin

An Unusual Occurrence of Trifluoperazine-Induced Nystagmus in Persistent Hallucinatory Disorder—A Case Report

Guidelines for Neuroprognostication in Comatose Adult Survivors of Cardiac Arrest

Contact Info

Product

Resources

About