What is it about?
This is a classic clinical case report about attention and memory problems and the associated cerebral atrophy observed in a painter who was chronically exposed to volatile organic solvents (e.g., toluene).
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Why is it important?
This clinical case study is important because it is one of the most well-investigated case of chronic toxic encephalopathy in a professional painter exposed to mixed volatile organic solvents ever reported in the peer-reviewed literature. This paper provides important details about the approach used in the differential diagnostic process. The paper presents results of the serial neuropsychological tests and magnetic resonance imaging (MRI) studies and discusses how these were used to differentiate chronic toxic encephalopathy from Alzheimer's disease in this case. This case report also reveals a relatively greater vulnerability of dynamic cognitive processes such as attention and executive function to the neurotoxic effects of volatile organic solvents. A detailed discussion of the mechanisms of action for the individual neurotoxic solvents and solvent mixtures found in paints and thinners is provided. In short, this case report is important because it serves as "the boiler plate" for all practicing clinicians and toxicologists who need to effectively make a differential diagnosis in suspected cases of chronic toxic encephalopathy.
Perspectives
This clinical case study was among the first I had the pleasure to work on with my former mentor Dr. Robert G. Feldman. I learned a lot from Bob and I continue to apply those lessons in my work as a neurotoxicologist. That said, it is important for me to mention that I actually followed up via a telephone interview with the patient and his family 15 years after this paper was published. Although the patient reportedly developed diabetes later in life, his cognitive function remained relatively stable over time this same time period and he never developed any type of progressive dementia such as Alzheimers disease.
Dr. Marcia H. Ratner
Boston University Chobanian & Avedisian School of Medicine
Read the Original
This page is a summary of: Chronic toxic encephalopathy in a painter exposed to mixed solvents., Environmental Health Perspectives, May 1999, Environmental Health Perspectives,
DOI: 10.1289/ehp.99107417.
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