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NEUROLOGY 1989;39:481
© 1989 American Academy of Neurology

Downbeating nystagmus and other ocular motor defects caused by lithium toxicity

J. J. Corbett, MD, D. M. Jacobson, MD, H. S. Thompson, MD, M. N. Hart, MD and D. W. Albert, MD

Department of Neurology, University of Iowa College of Medicine, Iowa City, IA (Dr. Corbett)
Department of Ophthalmology, University of Iowa College of Medicine, Iowa City, IA (Drs. Corbett and Thompson)
Department of Pathology, University of Iowa College of Medicine, Iowa City, IA (Dr. Hart)
Departments of Neurology and Ophthalmology, Marehfield Clinic, Marshfield, WI (Dr. Jacobson)
Department of Ophthalmology, University of Miami-Bascom Palmer Eye Institute, Miami, FL (Dr. Albeit).

We report the clinical and neuropathologic findings of a 63-year-old woman who died following an accidental lithium overdose that produced coma, respiratory depression, horizontal gaze palsy, and downbeating nystagmus. She also had mild hypomagnesemia. The pathology was cytotoxicity, predominantly in the regions of the nuclei prepositus hypoglossi and medial vestibular nucleus. Damage to this area with kainate and ibotenate in rhesus monkeys has produced horizontal gaze palsy and downbeating nystagmus. In addition, we report our clinical experience during the past 6 years with other examples of downbeating nystagmus in patients receiving lithium.

Address correspondence and reprint requests to Dr. Corbett, Department of Neurology, University of Iowa College of Medicine, Iowa City, IA 52242.

Supported in part by grant RR59 from the General Clinical Research Center Branch of the NIH, Bethesda, MD, and an unrestricted grant to the University of Iowa Department of Ophthalmology from Research to Prevent Blindness.

Presented in part at the sixteenth meeting of the Frank B. Walsh Society, Cleveland, OH, February 1984.

Received November 20, 1987. Accepted for publication in final form October 20, 1988.




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