Stellate ganglion block in treatment of total blindness due to quinine

Bricknell, P. P.; Middleton, Harry; Hollingsworth, Angela; Evans, Erica

doi:10.1136/bmj.4.5576.400

Cited by 18 publications

(6 citation statements)

References 5 publications

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“…Bilateral stellate ganglion block has been almost uniformly successful in improving vision dramatically in reported cases (Glick & Mumford, 1955;Bricknell et al, 1967;Kennerley Banks et al, 1972;Valman & White, 1977;Robertson & Raman, 1979) and is therefore definitely indicated when vision is impaired. It is recommended that it should be instituted as early as possible after ingestion and before the onset of blindness (Bricknell et al, 1967).…”

Section: Discussionmentioning

confidence: 95%

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Management of Quinine Overdose

Browne

Coppel

1984

Human Toxicology

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The successful management of a case of quinine overdose with blindness is described. From a review of the literature, treatment of moderate poisoning with ingestion of < 10 g of quinine should consist of immediate and thorough gastric lavage, forced acid diuresis, immediate bilateral stellate ganglion blockage repeated if there is clinical improvement in vision. With a larger overdose or when coma or convulsions occur haemodialysis, peritoneal dialysis or preferably haemoperfusion should be considered.

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Section: Discussionmentioning

confidence: 95%

“…It is recommended that it should be instituted as early as possible after ingestion and before the onset of blindness (Bricknell et al, 1967). It is not clear whether continuation of the block over several days is indicated (Drance, 1955;Turtz, 1957;Kennerley Banks et al, 1972) as some recovery tends to occur even without treatment.…”

Section: Discussionmentioning

confidence: 98%

Management of Quinine Overdose

Browne

Coppel

1984

Human Toxicology

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“…Fundoscopy is usually normal at the onset of visual symptoms but after blindness has developed there may be marked changes including constriction of retinal arterioles, retinal oedema and a cherry red spot at the macula. Optic atrophy may develop several weeks or months later (Elliott, 1918;Braveman et al, 1948;Stuart, 1963;Bricknell et al, 1967;Kennerley Bankes et al, 1972;Murray & Jay, 1983;Dyson et al, 1985;Canning & Hague, 1988).…”

Section: Discussionmentioning

confidence: 99%

“…The commonest method used has been SGB. The vascular effects of SGB occur within minutes of the procedure (Bricknell et al, 1967), whereas in cases where visual improvement was attributed to SGB it usually started some hours after the block was performed (Murray & Jay, 1983;Thomas, 1984;Dyson et al, 1985;Bacon et al, 1988). This suggests that the observed recovery was due to spontaneous improvement.…”

Section: Discussionmentioning

confidence: 99%

The management of quinine-induced blindness.

Guly

Driscoll²

1992

Emergency Medicine Journal

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Quinine is rarely taken in overdose (Pearn et al., 1984;Boland et al., 1985). We present a case where blindness resulted from an accidental overdose of only eight tablets of quinine sulphate. Opinion regarding both the aetiology and the management of quinine-induced blindness has altered in recent years (Boland et al., 1984;Dyson et al., 1985;Dyson et al., 1986). This case suggests that expert advice received regarding this condition may not be that recommended in the light of these changes.Case report A 40-year-old man presented to the A&E Department at Hope Hospital at 9 a.m. having become blind overnight. At 8 p.m. the previous day he had developed a mild frontal headache and had taken two of his father's tablets which he believed to be painkillers. His headache did not improve and over the next 8 h he took a further six tablets. During the night he noticed that the street lights became dim and disappeared. When he woke in the morning he was blind and had a buzzing noise in his ears.On examination both pupils were fixed and dilated and there was no light perception in either eye. Fundoscopy was normal. He appeared to have slight hearing impairment but examination was otherwise normal.He brought with him the bottle of tablets he had taken. This contained quinine sulphate tablets which had been prescribed for his father for muscle cramps.Gastric lavage was carried out and repeated doses of activated charcoal were given. The Poisons Information Centre recommended unilateral stellate ganglion block (SGB) after being seen by an opthalmologist. On the advice of the duty ophthalmologist bilateral SGBs were performed at 5.30 p.m.

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“…Stellate ganglion block in the treatment of quinine amblyopia was first used by Redslob et al (1946) and later by Glick and Mumford (1955), each group of authors reporting individual cases with good recovery of vision. Bricknell et al (1967) reported a case where the patient received 19 separate stellate ganglion blocks in seven days. We strongly recommend the use of stellate ganglion block in the emergency treatment of quinine amblyopia, as we believe that vasodilatation can favourably influence the direct toxic effect quinine has on the retinal ganglion cells.…”

Section: Commentmentioning

confidence: 99%