To the Editor.
—In the report by Williams et al in the September issue of the Archives,1 a 54-year-old woman was noted to have the abrupt onset of oscillopsia and downbeat nystagmus while receiving lithium carbonate for manic-depressive illness. After an evaluation revealed no other cause, her condition was thought to have been induced by lithium therapy, although the nystagmus continued for 2 years following the cessation of lithium treatment. In such cases, it is difficult to be sure that the cause is the medication and not a small stroke in the area of the craniocervical junction. In support of the conclusion by Williams and coworkers that lithium therapy can cause a permanent deficit, I have seen two very similar cases.
Report of Cases.
—Two women, both 64 years old, were taking lithium for bipolar disorder. Oscillopsia began while receiving the medication, and downbeat nystagmus developed on examination. Skew
Rosenberg ML. Permanent Lithium-Induced Downbeating Nystagmus. Arch Neurol. 1989;46(8):839. doi:10.1001/archneur.1989.00520440019004
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