Dehydration may contribute to the neurotoxicity of lithium.Lithium salts are commonly used for prophylaxis and treatment of bipolar disorder. Downbeating nystagmus and other ocular motor defects caused by lithium toxicity. Eye movement disorders in vitamin B12 deficiency: two new cases and a review of the literature. Ocular side effects of lithium-a review. 1981;38(10):650–2.Akdal G, Yener GG, Ada E, Halmagyi GM. Am J Ophthalmol. Am J Ophthalmol 1989; 107(6): 664-70.Akdal G, Yener GG, Ada E, Halmagyi GM. ScienceDirect ® is a registered trademark of Elsevier B.V.ScienceDirect ® is a registered trademark of Elsevier B.V. In addition, we report our clinical experience during the past 6 years with other examples of downbeating nystagmus in patients receiving lithium.We have changed the login procedure to improve access between AAN.com and the Neurology journals. J Am Optom Assoc 1991; 62(7): 548-51.Corbett JJ, Jacobson DM, Thompson HS, Hart MN, Albert DW. 1989;107(6):664–70.Haussmann R, Bauer M, von Bonin S, Grof P, Lewitzka U. Arch Neurol. Lithium-induced downbeat nystagmus. A safe blood level of lithium is 0.6 and 1.2 milliequivalents per liter (mEq/L). Am J Ophthalmol 1989; 107(6): 664-70.Corbett JJ, Jacobson DM, Thompson HS, Hart MN, Albert DW. Funduscopic examination showed mild incyclotorsion on right eye. Epilepsy Res. Downbeat nystagmus (DBN) is a well-known neurotoxic side effect of lithium treatment . We report a rare case of lithium-induced DBN combined with horizontal gaze palsy. Lithium-induced downbeat nystagmus (related to brainstem toxicity) has long been described as a side-effect unrelated to lithium plasma levels.1 A review of 12 cases published in 1989 2 suggested that nystagmus could persist despite discontinuation of the drug. However, the patient demonstrated downbeat nystagmus and 6 prism diopters of right hypertropia on the alternative prism cover testFundus photographs demonstrated mild incyclotorsion in the right eye, and the left eye was normalShe had a past medical history of bipolar disorder treated with lithium 600–900 mg per day for the past 6 years. Paraneoplastic autoantibodies in serum were negative for Anti-amphiphysin, anti-CV2, anti-PMNA2, anti-Ri, anti-Yo, anti-ANNA1. Serum lamotrigine and valproate levels were only analysed one week after lithium discontinuation when clinical signs and symptoms had improved significantly. 2016;87(19):2026–33.Saul RF, Selhorst JB. The neurology of eye movements. 1989;39(4):481–7.Grignon S, Bruguerolle B. Cerebellar lithium toxicity: a review of recent literature and tentative pathophysiology. 2014;25(6):485–7.Keane JR. Ocular skew deviation. Neuro-ophthalmic examination revealed upward gaze deviation, DBN and horizontal gaze palsy (Fig. In the absence of lithium overdose or use of concomitant medications known to increase lithium level, the most plausible cause of lithium toxicity appears to be fever in the setting of infection. 2 Johnson G. Lithium early development, toxicity, and renal function. Halmagyi The pathophysiology of lithium-induced DBN is not well understood. 1983;40(12):747–51.Schein F, Manoli P, Cathebras P. Lithium-induced downbeat nystagmus. 6 days after cessation of lithium, down beat nystagmus and right hypertropia were completely resolved and symptoms did not recur over a year.Even within a normal therapeutic range, downbeat nystagmus and skew deviation can occur as side effect of lithium. If you are experiencing issues, please log out of AAN.com and clear history and cookies. Downbeat nystagmus is a well-known potential presentation of lithium toxicity, while the most common ocular motor complication associated with lithium is horizontal gaze-evoked nystagmus . To our knowledge, this observation was only reported once previously [2 Corbett JJ, Jacobson DM, Thompson HS, Hart MN, Albert DW. 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 had no history of alcohol abuse or relevant viral infection.Interestingly, she experienced improvement in diplopia and oscillopsia just after consuming sports drinks or receiving intravenous fluid therapy. J Neurol 1986; 233(3): 145-8.Suzuki Y, Matsuda T, Washio N, Ohtsuka K. Transition from upbeat to downbeat nystagmus observed in a patient with Wernicke’s encephalopathy. Brain MRI was not performed and serum magnesium level was not evaluated due to patient refusal. Although ductions and versions were normal, she demonstrated 6 prism diopters (PD) of right hypertropia and downbeat nystagmus (Fig.