Imaging

Those who care for patients with pulmonary, critical care or sleep disorders rely heavily on chest radiology and pathology to determine diagnoses. The Southwest Journal of Pulmonary, Critical Care & Sleep publishes case-based articles with characteristic chest imaging and related pathology.

The editor of this section will oversee and coordinate the publication of a core of the most important chest imaging topics. In doing so, they encourage the submission of unsolicited manuscripts. It cannot be overemphasized that both radiologic and pathologic images must be of excellent quality. As a rule, 600 DPI is sufficient for radiographic and pathologic images. Taking pictures of plain chest radiographs and CT scans with a digital camera is strongly discouraged. The figures should be cited in the text and numbered consecutively. The stain used for pathology specimens and magnification should be mentioned in the figure legend. Those who care for patients with pulmonary, critical care or sleep disorders rely heavily on chest radiology and pathology to determine diagnoses. The Southwest Journal of Pulmonary, Critical Care & Sleep publishes case-based articles with characteristic chest imaging and related pathology. The editor of this section will oversee and coordinate the publication of a core of the most important chest imaging topics. In doing so, they encourage the submission of unsolicited manuscripts. It cannot be overemphasized that both radiologic and pathologic images must be of excellent quality. As a rule, 600 DPI is sufficient for radiographic and pathologic images. Taking pictures of plain chest radiographs and CT scans with a digital camera is strongly discouraged. The figures should be cited in the text and numbered consecutively. The stain used for pathology specimens and magnification should be mentioned in the figure legend.

Rick Robbins, M.D. Rick Robbins, M.D.

Medical Image of the Week: Prozac Eyes

Figure 1. 60-second epoch shows the slow rolling eye movements (red arrow) and rapid eye movements (green arrows) seen during NREM stage 2 sleep.

A 59-year-old man with a past medical history significant for hypertension, obesity and depression underwent an overnight polysomnogram for high clinical suspicion for obstructive sleep apnea. His current medications include doxepin, fluoxetine, bupropion, ambien and amlodipine. A snapshot during NREM sleep is shown (Figure 1).

Fluoxetine (Prozac®) is a potent selective serotonin reuptake inhibitor (SSRI).“Omnipause” neurons in the brainstem inhibit saccadic eye movements. NREM eye movements result from the potentiation of serotonergic neurons that inhibit these neurons (1). These eye movements occur during all stages of NREM sleep. These atypical eye movements have been reported to be present with a lower incidence with use of other antidepressants, benzodiazepines and neuroleptics and they tend to persist even after discontinuation of the medication (2). The clinical significance of these eye movements is unknown.

Safal Shetty MD, Sarah Patel MD, Kenneth S. Knox MD

Section of Pulmonary, Allergy, Critical Care & Sleep Medicine

Banner University Medical Center

Tucson, AZ USA

References

  1. Schenck CH, Mahowald MW, Kim SW, O'Connor KA, Hurwitz TD.Prominent eye movements during NREM sleep and REM sleep behavior disorder associated with fluoxetine treatment of depression and obsessive-compulsive disorder. Sleep. 1992;15(3):226-35. [PubMed]
  2. Geyer JD, Carney PR, Dillard SC, Davis L, Ward LC. Antidepressant medications, neuroleptics, and prominent eye movements during NREM sleep. J Clin Neurophysiol. 2009;26(1):39-44. [CrossRef] [PubMed] 

Cite as: Shetty S, Patel S, Knox KS. Medical image of the week: prozac eyes. Southwest J Pulm Crit Care. 2015;11(6):284. doi: http://dx.doi.org/10.13175/swjpcc128-15 PDF

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