Cases chronic toxic encephalopathy

Gamier R, Reygagne A, Maladry-Muller P, et al. 1991. [Evolution of chronic toxic encephalopathy induced by organic solvents after the cessation of exposure Report of a case with a 5-year followup.] Arch Mai Prof 52 349-354. (French)... 

Patients with acute and chronic Al encephalopathy can demonstrate unilateral or bilateral myoclonic jerks of the extremities for several months in the chronic form and days to weeks in the acute form, followed by convulsions and coma even when the exposure is terminated, ft seems as if brain pathology reaches a point of no return which results in frequent epileptic insults and inevitably leads to coma and death, either due to superimposed infections like aspiration pneumonia, or pulmonary edema due to cardiac toxicity. Recovery is exceptional in severe cases. In the past, reports showed that the early stages of chronic Al encephalopathy progressed to death, mainly because the most important source of Al, namely the dialysis fluid contamination, was not recognized as such and the exposure continued for months to years [10-17, 19-42]. 

Chronic application of 70% DEET solution caused paranoid psychosis, pressurized speech, flight of ideas, and delusions after 2 weeks of daily application for the inappropriate treatment of a skin rash. Repeated application causes erythema. Extensive daily dermal application of 10-15% DEET for 2 days to 3 months has resulted in encephalopathy in children. Toxic encephalopathy has been associated with DEET in children. Signs of toxicity included agitation, weakness, disorientation, ataxia, seizures, coma, and, in three cases, death. As part of the Reregistration Eligibility Decision on DEET released in 1998, however, the US Environmental Protection Agency reviewed all available data on the toxicity of DEET and concluded that... 

Environment and health-related problems are especially determined by health risks due to solvents, which result in damage to skin and the central nervons system (polyneuropathy, encephalopathy) in the case of chronic exposure. Some solvents are also classified as being carcinogenic (e.g. benzene, trichloroethylene) or are suspected of being carcinogenic (e.g. perchloroethylene) or reproduction-toxic (e.g. toluene). 

The decompensated stage, i.e. manifest liver insufficiency, can present as cellular decompensation (e. g. in the case of acute liver failure due to toxic or inflammatory mass necrosis) or be expressed only in the form of portal decompensation (e.g. in cases of postsinusoidal intra-hepatic portal hypertension). As a rule, chronic liver insufficiency is accompanied by a combined decompensation with a loss in function of the liver cells and, at the same time, the sequelae of portal decompensation (collateral varicosis, encephalopathy, ascites, hepatorenal syndrome, variceal bleeding), (see chapters 15 19 and 35)... 

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