toluene nerve damage

Clipboard, Search History, and several other advanced features are temporarily unavailable. There will be no recovery with neurotmesis. The cerebral white matter can be readily studied with MRS, and abnormalities of MR spectra have already been noted in many white matter disorders such as MS (39). On light microscopy of Case 1, Luxol fast blue-periodic acid-Schiff (LFB-PAS) staining showed severe myelin loss especially around blood vessels. If the damage is severe, paralysis may result; this paralysis is rarely permanent but recovery is slow. The abuse of volatile substances is an important problem in the United States and many other countries around the world (1). Although similar to the neurobehavioral changes of benzene-induced toxic effects, those of toluene toxicity are more severe. In addition, substance abusers may have coexistent disorders such as acquired immunodeficiency syndrome, traumatic brain injury, hepatic cirrhosis, and nutritional deficiencies that impact neuropathological studies. As mentioned, this solvent, like many others, is highly lipophilic , and in laboratory animals toluene is preferentially distributed in lipid-rich regions of the brain . Removal (amputation) of a toe, foot or even the lower leg may be necessary. However, the absorption of ingested toluene is slower than that of inhaled toluene. The idea that toluene may be most damaging when myelin is being formed is corroborated by animal studies demonstrating that rats show a permanent reduction in forebrain myelination after prenatal toluene exposure (50). Binswanger's disease: Case presentation and differential diagnosis. The mechanism of brain white matter injury from toluene is unknown. Nervous system effects can be temporary, such as headaches, dizziness, or unconsciousness. Sensory neuropathy. Inhalants, along with alcohol and marijuana, may serve as the initial substances of abuse for young people (3). The level of exposure also depends on the dose, duration, and work done [ 6 ]. An autopsied patient with chronic lacquer-thinner intoxication reported in 1976 showed peripheral neuropathy and long tract degeneration (44). Based largely on the initial studies of toluene leukoencephalopathy and multiple sclerosis (MS), both of which are excellent examples of white matter disorders that reliably alter neurobehavioral function, the notion of “white matter dementia” was proposed (25). It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. Pathophysiology of Toluene Brain Damage. Case 2 differed from Case 1 in that PAS-positive macrophages were considerably fewer, the myelin loss significantly less, and the gliosis was several times more intense than in Case 1. CAS Number: 15833-63-3. It occurs when the macrophages of an individual's own immune system damage the myelin sheaths that insulate the axon of the nerve. Rosenberg NL Grigsby J Dreisbach Jet al. Nerve damage is treated with conservative therapy or surgery. This brake cleaner contained 50%--60% hexane (composed of 20%--80% n-hexane), 20%--30% toluene, and 1%--10% each of methyl ethyl ketone (MEK), acetone, isopropanol, methanol, and mixed xylenes. Refer to the NIOSH Pocket Guide to Chemical Hazards for more information. University of Colorado School of Medicine. Two different studies in rats exposed to toluene by inhalation or by oral dosing showed that toluene concentrations were highest in brainstem areas (medulla, pons) with high lipid content (42, 51), and lowest in the cerebral cortex and hippocampus, where less myelin is found (42), underscoring the lipophilic distribution of toluene (1). Advanced neuroimaging techniques such as diffusion tensor imaging, magnetization transfer imaging, and magnetic resonance spectroscopy promise to improve the early recognition of leukoencephalopathy in individuals exposed to toluene when the potential for reversibility is maximal. Knitting, typing, and tying your shoes may become difficult. Other animal studies have raised the possibility that the hippocampus may be damaged by toluene, although the data are inconclusive and this area has not yet been shown to be preferentially affected in humans. In the cerebral hemispheres, periventricular white matter appeared to be most affected, with better preservation of subcortical U-fibers (41). Tualeka AR, Rahmawati P, Ahsan A, Pathak Y, Russeng SS, Sukarmin S, Wahyu A. The patient reported by Escobar et al also showed severe myelin, axon, and neuronal loss, and was acknowledged to abuse both “thinner” and “glue;” the authors acknowledged that he was therefore exposed to both toluene and n-hexane (40). Overall drug abuse among teenagers has declined in the past several years, but inhalant abuse is on the rise. Case 1 was a 33-year-old man with a history of paint and glue sniffing since age 11, and Case 2 was a 41-year-old woman who had been addicted to paint sniffing for at least 9 years and died while inhaling paint fumes and drinking alcohol. Long-term and intense exposure to toluene vapors in humans who abuse spray paint and related substances has led to the recognition that toluene has a severe impact on central nervous system myelin. Although toluene leukoencephalopathy is well documented in inhalant abusers, the potential of low-level occupational or household toluene exposure to cause brain damage is uncertain. B: Sagittal T1-weighted image of the same patient shown in (A), demonstrating thinning of the corpus callosum and cerebellar atrophy. For someone whose livelihood relies on their voice, the situation was confronting. Requirement Prediction for Toluene Detox with Foods Intake Rich in CYP2E1 Enzyme and Glycine to Prevent Nerve and Kidney Damage at Shoe Home Industry Workers in Romokalisari Surabaya. Nerve damage caused by diabetes is one of the most common forms of neuropathy. Although many inhalant abusers expose themselves to a wide variety of solvents, a subset of abusers confines themselves largely or exclusively to the inhalation of paint fumes. Indeed, a precise assessment of the extent of exposure to inhalants cannot usually be determined. Left untreated, nerve damage may worsen over time. Copyright © 2020 American Association of Neuropathologists. Toluene abuse in pregnancy causes a constellation of teratogenic features known as fetal solvent syndrome, which is similar to the fetal alcohol syndrome. BACKGROUND: Toluene was an organic compound used in chemical and drug industries, the main source of toluene emissions from fires. This leads to numbness, pain, and a loss of sensation in the extremities. Subsequently, an eloquent neuropathological study of two paint sniffers appeared in 1994 in this journal (43). Potential For Nerve Damage. The axon is damaged and the surrounding connective tissue remains intact (Figure 12). The cerebellar white matter, especially in the vermis, was more affected than cerebral white matter (43). A combination of sensory and motor neuropathy is particularly common (sensorimotor polyneuropathy). Copyright © 2004 by the American Association of Neuropathologists, Inc. Glioma-Derived TSP2 Promotes Excitatory Synapse Formation and Results in Hyperexcitability in the Peritumoral Cortex of Glioma, PTEN Blocking Stimulates Corticospinal and Raphespinal Axonal Regeneration and Promotes Functional Recovery After Spinal Cord Injury, Early Selective Vulnerability of the CA2 Hippocampal Subfield in Primary Age-Related Tauopathy, PCBP2 Is Downregulated in Degenerating Neurons and Rarely Observed in TDP-43-Positive Inclusions in Sporadic Amyotrophic Lateral Sclerosis, About Journal of Neuropathology & Experimental Neurology, The Public Health Impact of Inhalant Abuse, General Effects of Inhalants on the Brain, Acute Encephalopathy after Toluene Ingestion, Toluene Leukoencephalopathy due to Chronic Abuse, Neurobehavioral Deficits in Chronic Toluene Abuse, Toluene Leukoencephalopathy as an Example of White Matter Dementia, Neuroimaging Studies of White Matter Damage in Chronic Toluene Abuse, The Promise of Advanced Neuroimaging Techniques, Experimental Adult Animal Models of Chronic Toluene Abuse, Toluene as a Teratogen: The Fetal Solvent Syndrome, Receive exclusive offers and updates from Oxford Academic, Multifocal Necrotizing Leukoencephalopathy: Expanding the Clinicopathologic Spectrum, Pathologic Correlation of Paramagnetic White Matter Lesions in Adult-Onset Leukoencephalopathy With Axonal Spheroids and Pigmented Glia, Histopathologic Analysis of Cerebral Autosomal Recessive Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CARASIL): A Report of a New Genetically Confirmed Case and Comparison to 2 Previous Cases. Laboratory testing for acute toluene toxicity is hampered by the fact that blood tests for toluene and urinary tests for hippuric acid are not available in most hospitals. Urban Hispanic youth and Native Americans who reside on reservations manifest an even higher rate of inhalant abuse than the general population (1). There is no question that the leukoencephalopathy detected by conventional MRI scanning in chronic inhalant abusers represents the severe end of the spectrum of white matter injury, and is usually detected in individuals only after many years of heavy toluene abuse. Inhalant abuse appears to be startlingly high among younger aged children, with up to 10% to 15% of young people in the United States having used inhalants in some surveys (2). The demyelination was interpreted by the authors as being secondary to the neuronal loss. An area of uncertainty in the study of toluene leukoencephalopathy is the threshold of toluene exposure that is necessary to induce damage to the brain white matter. Obtundation may also lead to suffocation, hypothermia due to exposure, or fatal motor vehicle accidents. Rosenberg et al. Long term exposure to low levels of toluene has been speculated to cause neurobehavioral dysfunction, but the threshold of exposure above which leukoencephalopathy occurs is debated. 2H). 2F). Caldemeyer KS Pascuzzi RM Moran CG Smith RS. USA.gov. DTI has been used to detect microstructural lesions of white matter in stroke, leukoaraiosis, traumatic brain injury, neoplasms, and MS (33, 34), even in areas that appear to be normal on conventional MRI—the so-called “normal-appearing white matter” (NAWM; 35). A significant and selective decline of the WAIS-Revised performance intelligence quotient (IQ), and in particular the digit symbol subtest, was reported among a group of solvent abusers who had diffuse cerebral white matter changes on MRI (23). This type of damage often occurs as a natural part of the aging process. Epub 2019 Oct 23. Tests for toluene exposure, including quantitative analyses and screening panels for a number of other inhalants, are available at a limited number of reference laboratories in the country (such as National Medical Services in Willow Grove, Pennsylvania), but may require special shipping arrangements, such as sending the specimen chilled with a cold pack due to the highly volatile nature of these substances. He urged quick action in the event of an injury to ensure no lasting damage to the nerve. These observations support the notion that myelin, which contains 70% lipid, is targeted for damage. In this regard, it is noteworthy that of these four recent well-studied patients (41, 43, Case 2 1995 Diagnostic Slide Session of AANP), the two with the most severe myelin and axonal loss were both said to have a history of “paint and glue sniffing” (Case 1 of Kornfeld and colleagues, and the case of Dr. Halliday). Fibrillation is present and the injury usually requires surgery (Figure 13). The level of exposure also depends on the dose, duration, and work done [6]. As the damage gets worse, you will likely lose feeling in your toes, feet, and legs. This may in part be due to the fact that brain damage from chronic toluene abuse is probably under-recognized by pathologists. Chronic near lifetime toluene exposure in rodents does not replicate solvent abuse leukoencephalopathy in humans. A recent Forensic Pathology Check Sample case (FP00–2), from the American Society of Clinical Pathologists, reminds coroners and forensic pathologists of the potential for sudden demise during episodes of acute toluene inhalation. That way you can reduce the likelihood of permanent damage. Search for other works by this author on: Correspondence to: B. K. Kleinschmidt-DeMasters, MD, UCHSC B-216, 4200 East Ninth Avenue, Denver, CO 80262. Although conventional MRI allows visualization of detailed neuroanatomy, especially the cerebral white matter (7), it is not sufficiently sensitive to detect the earliest stages of white matter damage from toluene. Nerves can get damaged or injured sometimes as a result of a cut, excessive pressure, or excessive stretch of the nerve. system depression, nerve damage. 2H). In normal white matter, water diffusion is anisotropic (directional), occurring principally parallel to axons, and the degree of anisotropy detected by DTI provides information on the structural integrity of individual tracts; in contrast, isotropic diffusion indicates structural damage (32). In a follow-up study of 14 more toluene abusers, detailed neuropsychological testing and magnetic resonance imaging (MRI) scans showed that neuropsychological deficits in patients with toluene-induced white matter damage correlated with the patient's neuroimaging findings (22). n-Hexane--Related Peripheral Neuropathy Among Automotive Technicians --- California, 1999--2000. The gross pathology of toluene leukoencephalopathy is subtle and medical examiners/coroners, particularly those who cut the brain in the fresh state and do not take tissue sections for histology unless they see an obvious lesion, may miss this diagnosis. SDS; Triethylaluminum solution. It is also found in fuels. Chronic solvent-induced encephalopathy (CSE) is a condition induced by long-term exposure to organic solvents, often but not always in the workplace, that lead to a wide variety of persisting sensorimotor polyneuropathies and neurobehavioral deficits even after solvent exposure has been removed. Both acute and chronic encephalopathies are common (1). Hardware and other retail stores have been encouraged to store these substances in locked cabinets, but this procedure has not produced a major barrier to access. This study was important because it identified abnormalities in the brains of individuals who abused toluene and were not acutely intoxicated when tested, but it was apparent from the early days of CT that this technique could not provide detailed information on the brain white matter (26). Toluene abusers generally employ one of two methods to achieve a “high” with this substance: “huffing,” in which a rag is soaked with toluene and the fumes are directly inhaled, and “bagging,” in which the fumes are inhaled as they arise from the solvent placed in a plastic bag. Moreover, the observed deficits demonstrated a significant degree of correlation with the degree of cerebral white matter injury (24). He occasionally used a rag. 2D), numerous perivascular PAS-positive macrophages containing coarse and even linear debris (Fig. The clinical syndrome, toluene leukoencephalopathy, can be detected by a combination of characteristic symptoms and signs, detailed neurobehavioral evaluation, and brain magnetic resonance imaging. So, maintain a healthy diet, carry on with your regular exercise, follow the advice of your doctors and take rest. DTI is a neuroimaging technique that offers a means of imaging the microstructure of brain white matter based on the diffusion of water molecules in the brain (32). The insensitivity of standard MRI to mild degrees of toluene leukoencephalopathy hampers early detection of individuals at risk, and it is therefore possible that a crucial opportunity for effective intervention is lost. In the first long term look at how solvents affect the brain, researchers say some chemicals are linked to cognitive problems 30 years after exposure Peripheral nerves were also affected. Genetic and Pathological Characteristic Patterns of a Family With Neuronal Intranuclear Inclusion Disease. Benzoic acid is then conjugated with glycine to form hippuric acid (80%) or glucuronic acid to form benzoylglucuronide (20%), both of which are water soluble and readily eliminated through the kidneys (8). Neurotoxicology. See also the symptoms of Occupational liver damage -- Toluene and Occupational liver damage -- Toluene: Introduction. Cell Mol Neurobiol. Campos-Ordonez T, Zarate-Lopez D, Ibarra-Castaneda N, Buritica J, Gonzalez-Perez O. 2E), and trilaminar inclusions by EM (Fig. Also, it can sometimes make non-pain signals feel painful. Because nerve damage is often progressive, it is important to consult with a doctor when you first notice symptoms. In contrast to neurotoxic agents that disrupt neurotransmitter or receptor function and elicit no structural changes, damage to brain myelin has been well documented with chronic toluene abuse, although a surprisingly small number of autopsy cases have been reported (40–43). His autopsy findings, coupled with MRI data, were the first to confirm that the brunt of the toxic damage from toluene is directed toward the CNS white matter. Is 0.5 to 3 days ( 9 ):457. doi: 10.3390/molecules25204866 when the toluene nerve damage of an individual own. 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