Pseudoneurotoxic disease
Citation Manager Formats
Make Comment
See Comments
![Loading Loading](https://n.neurology.org/sites/all/modules/contrib/panels_ajax_tab/images/loading.gif)
This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
Most instances of individual genuine neurotoxic disease in North America are pharmacologic; recognition of the causative agent is seldom difficult, for example, taxane neuropathy and chlorpromazine dyskinesia.1 Syndromes associated with familiar industrial toxins or abuse chemicals such as n-hexane neuropathy and toluene leukoencephalopathy are also readily identified. The consulting neurologist, although seldom initially called to see occupation-related cases, has little difficulty recognizing these well-described entities.
Precise diagnosis of unusual neurotoxic diseases can be difficult. In such instances, clinical toxicologists are useful in defining genuine disorders with detectable body burdens, such as arsenic or mercury; neurologists are most helpful in excluding instances of clear-cut naturally occurring conditions. Knowledge of the cardinal tenets of neurotoxic disease assists in its recognition.2 The basic dilemma is determining whether a symptomatic individual exposed to a putative neurotoxin has one of four conditions: a genuine neurotoxic disorder, the coincident new onset of a naturally occurring nervous system disease, psychogenic illness, or worsening of a pre-existing neurologic or psychological disorder. The latter three conditions represent three varieties (Types 1, 2, and 3) of a newly recognized entity: pseudoneurotoxic disease2 (table). The cases presented here exemplify each type and are selected from the authors’ experience of >200 individuals with these conditions. We have modified nonrelevant details of Cases 2 and 3 to preserve the anonymity of the patients and the patients’ families.
- In this window
- In a new window
Table Diagnostic features of Types 1, 2, and 3 pseudoneurotoxic disease
Type 1 pseudoneurotoxicity attributes instances of a naturally occurring nervous system disease (multiple sclerosis, Alzheimer disease) or condition (age-related cognitive decline, relative performance weaknesses within the normal range) to coincident chemical exposure. This is exemplified by epidemics of “painters’ encephalopathy,” an illness attributed, primarily in Scandinavian reports, to chronic low-level organic solvent exposure.3 Most patients assigned this diagnosis have alternative …
AAN Members
We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.
AAN Non-Member Subscribers
Purchase access
For assistance, please contact:
AAN Members (800) 879-1960 or (612) 928-6000 (International)
Non-AAN Member subscribers (800) 638-3030 or (301) 223-2300 option 3, select 1 (international)
Sign Up
Information on how to subscribe to Neurology and Neurology: Clinical Practice can be found here
Purchase
Individual access to articles is available through the Add to Cart option on the article page. Access for 1 day (from the computer you are currently using) is US$ 39.00. Pay-per-view content is for the use of the payee only, and content may not be further distributed by print or electronic means. The payee may view, download, and/or print the article for his/her personal, scholarly, research, and educational use. Distributing copies (electronic or otherwise) of the article is not allowed.
Letters: Rapid online correspondence
REQUIREMENTS
You must ensure that your Disclosures have been updated within the previous six months. Please go to our Submission Site to add or update your Disclosure information.
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
You May Also be Interested in
Dr. David Beversdorf and Dr. Ryan Townley
► Watch
Related Articles
- No related articles found.
Topics Discussed
Alert Me
Recommended articles
-
Articles
Occupational solvent exposure and cognitionDoes the association vary by level of education?E.L. Sabbath, M.M. Glymour, C. Berr et al.Neurology, May 28, 2012 -
Part III: Selected Reviews
Exposure to organic solvents and multiple sclerosisAnne-Marie Landtblom et al.Neurology, August 01, 1997 -
Article
Risk factors for possible REM sleep behavior disordersA community-based study in BeijingHui Zhang, Zhuqin Gu, Chun Yao et al.Neurology, August 11, 2020 -
Article
Time may not fully attenuate solvent-associated cognitive deficits in highly exposed workersErika L. Sabbath, Laure-Anne Gutierrez, Cassandra A. Okechukwu et al.Neurology, May 12, 2014