Neurologic Symptoms

Eczematous skin lesions are characterized by their chronic evolution and their frequent spread, despite the topical administration of corticosteroids. They are caused, as was shown by Hjorth and Trolle-Lassen (1963), by parabens contained in corticosteroid ointments. Patch tests done with different types of parabens yielded positive responses. Local application of pure corticosteroids, without preservatives, brought about rapid healing. This type of allergy, falsely related to corticosteroids, was particularly studied by Shorr (1968) 1 % of his patients treated for chronic dermatitis suffered from this allergy. 

This type of reaction consists of the isolated or associated occurrence of urticaria, angioedema, cardiovascular collapse and severe bronchospasm. These reactions 

In summary, it seems that immunologic mechanisms can explain some accidents induced by topical or systemic administration of corticosteroids. These reactions are exceptionally due to the corticosteroids themselves but generally seem to be related to the preservatives. 

Benos S, Koutsoukos A, Kelaidis E (1973) Reactions allergiques observees cours de I admi-nistration intermittente a longue echeance du Tetracosactide-retard. Rev Fr Allergol 13 107 

Brodewall EK (1954) Allergic reactions due to corticotrophin. North Am Med 51 303 Brown EM, Hollander JL (1951) Allergy to ACTH and the use of beef ACTH. In Proceedings, II clinical ACTH conference. Blakiston Division, McGraw-Hill, New York Philadelphia, p 391 

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Deficiency. Macrocytic anemia, megaloblastic anemia, and neurological symptoms characterize vitamin B 2 deficiency. Alterations in hematopoiesis occur because of the high requirement for vitamin B 2 for normal DNA repHcation necessary to sustain the rapid turnover of the erythrocytes. Abnormal DNA repHcation secondary to vitamin B 2 deficiency produces a defect in the nuclear maturational process of committed hematopoietic stem cells. As a result, the erythrocytes are either morphologically abnormal or die during development. 

Neurological symptoms result from demyelination of the spinal cord and are potentially irreversible. The symptoms and signs characteristic of a vitamin B 2 deficiency include paresthesis of the hands and feet, decreased deep-tendon reflexes, unsteadiness, and potential psychiatric problems such as moodiness, hallucinations, delusions, and psychosis. Neuropsychiatric disorders sometimes develop independently of the anemia, particularly in elderly patients. Visual loss may develop as a result of optic atrophy. 

The adverse effects iaclude digestive disturbances, neurological symptoms, and manifestations of allergic responses. As many as half of the patients taking it are iacapacitated by some of these adverse reactions for several hours. Whether these symptoms are caused by hypersensitivity to the dmg, the parasite, or by a manifestation of the disease is not known. Overall, effects are dose-related and transient. 

Indirect evidence indicates that dermal absorption occurs in animals. Calves dusted with a 4% dust formulation of endosulfan had neurological symptoms (tremors, twitching, convulsions) and died within a day after exposure (Nicholson and Cooper 1977). Neurological effects have also been reported in preclipped rabbits and rats after repeated application of endosulfan to the skin (Dikshith et al. 1988 Gupta and Chandra 1975). Dikshith et al. (1988) reported levels of a-, [3-, and total endosulfan in liver, kidney, brain, testes, fatty tissue, and blood 30 days after dermal application of endosulfan. 

Immune reconstitution inflammatory syndrome AIDS on HAART Acute or subacute Worsening or new neurological symptoms in the setting of immune reconstitution Immune mediated... 

Berman NE, Marcario JK, Yong C et al (1999) Microglial activation and neurological symptoms in the SIV model of NeuroAIDS association of MHC-II and MMP-9 expression with behavioral deficits and evoked potential changes. Neurobiol Dis 6 486 98 Biber K, Zuurman MW, Dijkstra IM et al (2002) Chemokines in the brain neuroimmunology and beyond. Curr Opin Pharmacol 2 63-68... 

Systemic signs (e.g., fever, weight loss, accelerated hypertension) Focal neurologic symptoms (i.e., other than typical visual or sensory aura)... 

H = Headaches. Headaches (particularly those associated with focal neurologic symptoms, such as blurred vision, speech impairment, and/or weakness) may represent strokelike symptoms. Headaches also may indicate poorly controlled blood pressure. 

In patients with vitamin B12 deficiency, methylmalonic acid and homocysteine levels may be high. Monitor for resolution of neurologic symptoms (i.e., confusion and paresthesias), if applicable, and Hgb levels periodically until the levels normalize. 

Neurologic symptoms (meningoencephalitis, aseptic meningitis, peripheral neuropathy, facial palsy, or cognitive impairment or psychosis)... 

Brain metastasis is common in melanoma, and treatment options for brain metastasis include surgery, radiation, and chemotherapy. The choice of therapy depends on the number of metastatic lesions, accessibility of the lesions for surgery, the presence of neurologic symptoms, and the status of extracranial disease. 

New cerebral neurologic symptoms in a cancer patient should initiate evaluation for brain metastases. 

Aerosols of Cellulube 220 produced deaths associated with severe dyspnea and mild diarrhea in one of two rabbits exposed to 2,000 mg/m3 for <4 hours/day, 5 days/week for 11 or 22 days (Carpenter et al. 1959). Continuous exposure for 30-160 days to aerosols of a triaryl phosphate U.S. military hydraulic fluid (see Table 3-2), at concentrations <110 mg/m3, produced no deaths in dogs or rats, but deaths associated with severe neurotoxic symptoms occurred in chickens exposed to concentrations >23 mg/m3 and in rabbits exposed to 102 mg/m3 (Siegel et al. 1965). Aerosols of Durad MP280 or Fyrquel 220 (continuous exposure for 90 days) produced no deaths in rats or hamsters exposed to 100 mg/m3. Deaths associated with lethargy, cachexia, and head droop occurred in rabbits exposed to 101 mg/m3 Durad MP280, but not in rabbits exposed to 100 mg/m3 Fyrquel 220 (MacEwen and Vemot 1983). Some of the Durad MP280-exposed rabbits were also infected with Pasteurella, which may have contributed to neurological symptoms. No deaths occurred in rats exposed to cyclotriphosphazene at 990 mg/m3, 6 hours/day,... 

De Marco et al. 49 Paromomycin (open) 6-12 days NH3, state of consciousness, intellectual functions, behavior, neurological symptoms E Rif =E Par T Rif > Par... 

The initial neurological symptoms of hypoxia and hypoglycemia result from reduced synthesis of neurotransmitters rather than a global cerebral energy deficit 594... 

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