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Journal of Neurology

, Volume 259, Issue 4, pp 773–774 | Cite as

Upbeat nystagmus as a clinical sign of physostigmine-induced right occipital non-convulsive status epilepticus

  • H. NeugebauerEmail author
  • T. Winkler
  • B. Feddersen
  • H. W. Pfister
  • S. Noachtar
  • A. Straube
  • T. Pfefferkorn
Letter to the Editors

Dear Sirs,

The main indication for use of physostigmine is treatment of anticholinergic coma after anaesthesia and intoxication. Generalized epileptic seizures are known complications of physostigmine, whereas focal seizures and non-convulsive status epilepticus (NCSE) have not been described as complications in this setting [1]. Epileptic nystagmus (EN) is a rare clinical sign of seizures defined as repetitive jerking of the eyes secondary to epileptic activity. EN usually occurs as horizontal nystagmus with its fast phase beating away from the epileptogenic hemisphere [2]. Purely vertical beating EN on the contrary is unusual and has been described only a few times in the setting of bilateral epileptic activity [3]. We present a patient in whom cholinergic treatment with physostigmine resulted in right occipital NCSE presenting with upbeat nystagmus and prolonged impairment of consciousness documented on video electroencephalogram (EEG).

A 66-year-old woman with history of drug abuse...

Keywords

Occipital Lobe Physostigmine Glasgow Coma Score Perfusion Compute Tomography Epileptic Activity 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Conflict of interest

None.

Supplementary material

Supplementary material 1 (WMV 1857 kb)

Supplementary material 2 (WMV 1352 kb)

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • H. Neugebauer
    • 1
    Email author
  • T. Winkler
    • 1
  • B. Feddersen
    • 1
  • H. W. Pfister
    • 1
  • S. Noachtar
    • 1
  • A. Straube
    • 1
  • T. Pfefferkorn
    • 1
  1. 1.Department of NeurologyLudwig-Maximilians UniversityMunichGermany

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