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Toxicology – Nystagmus-Inducing Toxins
Sedative–Hypnotics
Medications in this class commonly produce nystagmus as part of central nervous system depression.
Alcohols (Ethanol, Methanol, Ethylene Glycol, Isopropanol)
All alcohols can induce nystagmus. Ethanol is particularly associated with horizontal and downbeat nystagmus and is often assessed clinically using the horizontal gaze nystagmus test.
Phencyclidine and Dissociatives
Dissociative agents such as PCP, ketamine, and dextromethorphan can produce a characteristic rotatory nystagmus.
Phenytoin
Phenytoin toxicity is associated with horizontal and sometimes upbeat nystagmus.
Carbamazepine (Tegretol)
Carbamazepine can cause both horizontal and downbeat nystagmus.
Lithium
Lithium toxicity may lead to downbeat nystagmus.
Solvents (Inhalants)
Exposure to inhaled solvents has been associated with positional nystagmus, with severity correlating to the degree of exposure.
Thiamine Deficiency (Wernicke Encephalopathy)
Thiamine deficiency can result in Wernicke encephalopathy, characterized by ataxia, confusion, ophthalmoplegia, and nystagmus.
Overview
Nystagmus is an involuntary, rhythmic oscillation of the eyes that may occur in toxicologic conditions. It can present as horizontal (side-to-side), vertical (upbeat or downbeat), or rotatory movement. Horizontal nystagmus is the most common and is best observed during lateral gaze. Alcohol intoxication frequently produces nystagmus, which is often assessed in clinical and roadside settings. Certain agents such as anticonvulsants and lithium may produce vertical nystagmus, while phenytoin has been associated with upbeat nystagmus and PCP with rotatory nystagmus.
Sedative–Hypnotics
Medications in this class commonly produce nystagmus as part of central nervous system depression.
Alcohols (Ethanol, Methanol, Ethylene Glycol, Isopropanol)
All alcohols can induce nystagmus. Ethanol is particularly associated with horizontal and downbeat nystagmus and is often assessed clinically using the horizontal gaze nystagmus test.
Phencyclidine and Dissociatives
Dissociative agents such as PCP, ketamine, and dextromethorphan can produce a characteristic rotatory nystagmus.
Phenytoin
Phenytoin toxicity is associated with horizontal and sometimes upbeat nystagmus.
Carbamazepine (Tegretol)
Carbamazepine can cause both horizontal and downbeat nystagmus.
Lithium
Lithium toxicity may lead to downbeat nystagmus.
Solvents (Inhalants)
Exposure to inhaled solvents has been associated with positional nystagmus, with severity correlating to the degree of exposure.
Thiamine Deficiency (Wernicke Encephalopathy)
Thiamine deficiency can result in Wernicke encephalopathy, characterized by ataxia, confusion, ophthalmoplegia, and nystagmus.
Overview
Nystagmus is an involuntary, rhythmic oscillation of the eyes that may occur in toxicologic conditions. It can present as horizontal (side-to-side), vertical (upbeat or downbeat), or rotatory movement. Horizontal nystagmus is the most common and is best observed during lateral gaze. Alcohol intoxication frequently produces nystagmus, which is often assessed in clinical and roadside settings. Certain agents such as anticonvulsants and lithium may produce vertical nystagmus, while phenytoin has been associated with upbeat nystagmus and PCP with rotatory nystagmus.
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