Case files of the New York City poison control center: paradichlorobenzene-induced leukoencephalopathy
| Autor: | Stephanie H. Hernandez, Sage W. Wiener, Stephen W. Smith |
|---|---|
| Rok vydání: | 2010 |
| Předmět: |
Adult
Male Insecticides Toxicology Case Files Supine position Poison Control Centers Substance-Related Disorders Health Toxicology and Mutagenesis Poison control Physical examination Hyperreflexia Toxicology Chlorobenzenes Xenobiotics Leukoencephalopathies Heart rate medicine Humans Neurologic Examination medicine.diagnostic_test business.industry Magnetic Resonance Imaging Clonus Blood pressure Anesthesia Vomiting Pica Kidney Diseases New York City medicine.symptom business Blood Chemical Analysis |
| Zdroj: | Journal of medical toxicology : official journal of the American College of Medical Toxicology. 6(2) |
| ISSN: | 1556-9039 |
| Popis: | Keywords Ataxia.Encephalopathy.Leukoencephalopathy.Moth ball(s).Paradichlorobenzene.White matter diseaseCase PresentationA 44-year-old man was brought to the emergency depart-mentbyemergencymedicalservicesafterhewasdiscoveredlying supine on his apartment floor. He was accompanied byhissister,whohaddecidedtovisithimafterhisabsencefroma family function. Worsening “bizarre” behavior had beennoted by family members for 4 weeks, characterized byanorexia, social withdrawal, flat affect, and alogia. Prior tohis illness, he was described as functional, independent,gainfully employed, and social.The patient had mild mental retardation and hyperten-sion. There was no history of diagnosed psychiatric illness,although his family suspected pica. Medications includedan unknown antihypertensive with which he was notcompliant. He occasionally used marijuana and alcohol,without history of other abused drugs. The patient’s sisterreported significant weight loss over several months.There had been no apparent fevers, cough, vomiting,diarrhea, or convulsions. On physical examination, heappeared drowsy, was markedly cachectic, and emanatedan atypical aromatic body odor. Initial vital signs were:blood pressure 154/90 mmHg, heart rate 98/min, respira-tory rate 20/min, rectal temperature 37.4°C, and room airoxygen saturation 97%. Head, neck, chest, and abdominalexaminations were unremarkable. He had dry, scaling, andichthyotic skin. He was oriented to person and place, butnot to time, date, or indication for hospitalization. Limitedcranial nerve evaluation was normal. Pain and light-touchsensation were unaffected. Hyperreflexia (without clonus)and cogwheel rigidity were noted in both lower extrem-ities; upper extremities were normal. Plantar reflexes werenormal bilaterally. Muscle bulk, tone, and strength werenormal. The patient was unable to stand without supportand unable to ambulate, apparently due to impairedequilibrioception. He could follow simple one-step com-mands. He would speak a few words when asked simplequestions, and he avoided eye contact.Serum electrolytes (sodium, potassium, chloride, calcium,and magnesium) and serum glucose were normal. Tests ofhepatic and renal function were: AST 53 U/l (0–40 U/l), ALT25U/l(10–40U/l),alkalinephosphatase88U/l(35–145U/l),total bilirubin 6.84 μmol/l (0.4 mg/dl) (0–20.52 μmol/l; 0–1.2 mg/dl), ammonia 31 μmol/l (43.42 μg/dl) (11–35 μmol/l |
| Databáze: | OpenAIRE |
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