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Arsenical peripheral neuropathy

T. Beritić ; Institut za medicinska istraživanja Zagreb
Vinka Ivačić-Bonaček ; Neuropsihijatrijska klinika Medicinskog fakulteta, Zagreb

Puni tekst: hrvatski pdf 22.322 Kb

str. 267-285

preuzimanja: 196



The acute symptoms of nausea, vomiting and diarrhoea appeared in two patients 1 and 2 hours respectively after suicidal ingestion of white arsenic. A history of nausea and vomiting was also obtained in the third patient but neither the patient nor his physician associated these symptoms with exposure to arsenic; no source of arsenical poisoning could have been determined in this patient. In two cases symptoms of peripheral neuropathy were noted one week after the (presumptive) exposure and in the third six weeks after ingestion of arsenic. The onset of neurologic manifestations was characterized by the appearance of muscle cramps and of numbness in the feet and lower legs, later also in the hands. Within a few days of the onset of sensory symptoms, weakness developed in the feet and legs. Sensory disturbances in the hands, fed and legs showed a symetrical »stocking-glove« distribution. The loss of vibratory and position sensations was also noted. All three patients had evidence of foot drop and two of them were unable to walk. The tendon reflexes at the ankle and knee were absent in all three patients. Other· signs of arsenical poisoning were also found: typical Mees's lines, soft, pitting edema of the legs, and in two cases leukopenia with eosinophilia. High levels of arsenic were found in the hair of two patients (including one with no known exposure) while in one no analyses for arsenic were carried out. The patients were treated with BAL (2,3-dimercaptopropanol) but failed to show any evidence of rapid improvement or any accelerated recovery of sensory and motor function. Moreover, in one patient peripheral neuropathy developed in spite of early and adequate BAL therapy for acute arsenical poisoning. A delayed onset of neurologic manifestations in this patient (six weeks after ingestion of arsenic) might well be the only beneficial influence attributable to BAL therapy.

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