Article: article from journal or magazin.
Case report (case report): feedback on an observation with a short commentary.
Blood-brain barrier disruption associated with topiramate-induced angle-closure glaucoma of acute onset.
Klinische Monatsblätter für Augenheilkunde
Publication types: Case Reports ; Journal Article - Publication Status: ppublish
BACKGROUND: Topiramate (Topamax(R)) is an anti-epileptic drug of the sulfamate group used secondarily for bipolar disease. HISTORY AND SIGNS: One week after initiation of topiramate treatment for a bipolar disorder, a 57-year-old man presented with blurred vision. Clinical examination revealed a bilateral conjunctivitis, areflexic mydriasis, severe anterior chamber shallowing, with a myopic shift and vitritis. THERAPY AND OUTCOME: A spinal tap revealed an increased protein content of 1581 mg/L on cerebrospinal fluid (CSF) analysis, being compatible with a rupture of the blood-brain barrier (BBB). UBM exposed bilateral ciliochoroidal effusions with secondary angle-closure. Topiramate was promptly discontinued, whereas visual acuity, intraocular pressure (IOP), and anterior and posterior segments anatomy normalized within 1 week. One month later, bilateral iris atrophy was present. CONCLUSION: The presence of BBB disruption with increased protein content in CSF with simultaneous blood ocular barrier breakdown may suggest a common inflammatory mechanism.
Acute Disease, Anticonvulsants, Blood-Brain Barrier, Fructose, Glaucoma, Angle-Closure, Humans, Male, Middle Aged, Myopia
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