Parkinsonism secondary to ethylene oxide exposure

Barbosa, Egberto R.; Comerlatti, Luiz R.; Haddad, Monica S.; Scaff, Milberto

doi:10.1590/S0004-282X1992000400020

Abstracts

Ethylene oxide is a gas widely used in the production of industrial chemicals. It is also used to sterilize heat-sensitive medical supplies. Previous reports of acute and chronic exposure have described neurotoxic effects like peripheral neuropathy and cognitive impairment. We describe a pure parkinsonian syndrome following acute ethylene oxide intoxication. A 39-years-old male was referred to our Movement Disorders Clinic tor evaluation of a parkinsonian syndrome. He was acutely exposed to ethylene oxide four years before and remained comatose for three days, and gradually regained consciousness.. At that time he showed a global parkinsonian syndrome including bradykinesia, rigidity and rest tremor, with a severe motor disability; no other neurological disorders were found. The symptomatology was partially controlled with biperidene and levodopa plus carbidopa. Two years later he developed L-dopa induced dyskinesias. Four years after the intoxication he was evaluated at our clinic. General examination showed no abnormalities. Neurologic examination revealed a normal menta1 status. Motor evaluation disclosed moderate bradykinesia, rigidity and rest tremor, shuffling gait, poor facial mimic, stooped posture, and his speech was low and monotonous; deep tendon reflexes were brisk. The Hoehn-Yahr disability score was degree IV. Routine laboratory and radiological exams showed results within normal limits. The CSF examination was normal. Brain computed tomography and magnetic ressonance were normal. A trial with bromocriptine and levodopa plus carbidopa did not improve dyskinesia, and he was put on a schedule including amantadine and biperidene with improvement to grade III in Hoehn-Yahr scale. In the present case there was a clear relation between the acute exogenous intoxication and irreversible parkinsonism. No other causes for the condition were identified.

parkinsonism; ethylene oxide; exogenous intoxication (acute)

Parkinsonismo consequente a intoxicações exógenas tem sido relatado desde o início do século. Os agentes mais comumente implicados são o manganês, o monóxido de carbono e o sulfureto de carbono. No presente relato descreve-se síndrome parkinsoniana consequente a exposição aguda ao óxido de etileno. Manifestações neurológicas como neuropatia periférica e distúrbios cognitivos relacionados à exposição a este gás foram previamente descritas, porém não foi encontrada na literatura registro de parkinsonismo consequente a esse tipo de intoxicação exógena.

parkinsonismo; óxido de etileno; intoxicação exógena (aguda)

Egberto R. Barbosa^II; Luiz R. Comerlatti^II; Monica S. Haddad^I; Milberto Scaff^III

^IMédica Preceptora. Trabalho desenvolvido pelo Grupo de Estudos de Distúrbios do Movimento da Divisão de Clínica Neurológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP)

^IIMédico Assistente. Trabalho desenvolvido pelo Grupo de Estudos de Distúrbios do Movimento da Divisão de Clínica Neurológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP)

^IIIProfessor Titular. Trabalho desenvolvido pelo Grupo de Estudos de Distúrbios do Movimento da Divisão de Clínica Neurológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP)

RESUMO

Parkinsonismo consequente a intoxicações exógenas tem sido relatado desde o início do século. Os agentes mais comumente implicados são o manganês, o monóxido de carbono e o sulfureto de carbono. No presente relato descreve-se síndrome parkinsoniana consequente a exposição aguda ao óxido de etileno. Manifestações neurológicas como neuropatia periférica e distúrbios cognitivos relacionados à exposição a este gás foram previamente descritas, porém não foi encontrada na literatura registro de parkinsonismo consequente a esse tipo de intoxicação exógena.

Palavras-chave: parkinsonismo, óxido de etileno, intoxicação exógena (aguda).

SUMMARY

Ethylene oxide is a gas widely used in the production of industrial chemicals. It is also used to sterilize heat-sensitive medical supplies. Previous reports of acute and chronic exposure have described neurotoxic effects like peripheral neuropathy and cognitive impairment. We describe a pure parkinsonian syndrome following acute ethylene oxide intoxication. A 39-years-old male was referred to our Movement Disorders Clinic tor evaluation of a parkinsonian syndrome. He was acutely exposed to ethylene oxide four years before and remained comatose for three days, and gradually regained consciousness.. At that time he showed a global parkinsonian syndrome including bradykinesia, rigidity and rest tremor, with a severe motor disability; no other neurological disorders were found. The symptomatology was partially controlled with biperidene and levodopa plus carbidopa. Two years later he developed L-dopa induced dyskinesias. Four years after the intoxication he was evaluated at our clinic. General examination showed no abnormalities. Neurologic examination revealed a normal menta1 status. Motor evaluation disclosed moderate bradykinesia, rigidity and rest tremor, shuffling gait, poor facial mimic, stooped posture, and his speech was low and monotonous; deep tendon reflexes were brisk. The Hoehn-Yahr disability score was degree IV. Routine laboratory and radiological exams showed results within normal limits. The CSF examination was normal. Brain computed tomography and magnetic ressonance were normal. A trial with bromocriptine and levodopa plus carbidopa did not improve dyskinesia, and he was put on a schedule including amantadine and biperidene with improvement to grade III in Hoehn-Yahr scale. In the present case there was a clear relation between the acute exogenous intoxication and irreversible parkinsonism. No other causes for the condition were identified.

Key words: parkinsonism, ethylene oxide, exogenous intoxication (acute).

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Dr. Egberto Reis Barbosa Clínica Neurológica, Hospital das Clinicas, FMUSP - Caixa Postal 8091 - 01065 São Paulo SP - Brasil.

1. Bagg E, Gatto EM, Micheli F, Fernandez-Pardal MM. Parkinsonismo inducido por n-hexa-nos. VIII Congresso Panamericano de Neurologia. 6-12 de outubro 1991, Montevideo, Uruguay.
2. Crystal HA, Schaumburg HH, Grober El, Fuld PA, Lipton RB. Cognitive impairment and sensory loss associated with chronic low-level ethylene oxide exposure. Neurology 1988, 38:567-569.
3. De Poorter MC, Leys D, Godefroy O, De Revek J, Petit H. Carbon monoxide induced parkinsonism: preliminary results of bromocriptine therapy. Rev Neurol (Paris) 1991, 147:399-403.
4. Estrin WJ, Cavalieri SA, Wald P, Beck CE, Jones JR, Cone JE. Evidence cf neurologic dysfunction related to long-term ethylene oxide exposure. Arch Neurol 1987, 44:1283-1286.
5. Fahn S. Secondary parkinsonism. In Goldensohn ES, Appel SH (eds) : Scientific Approach to Clinical Neurology. Philadelphia : Lea and Febiger, 1977, p 1159-1189.
6. Ferraz HB, Bertolucci PHF, Pereira JS, Lima JGC, Andrade LAF. Chronic exposure to the fungicide maneb may produce symptoms and signs of CNS manganese intoxication. Neurology 1988, 38:550-553.
7. Finelli PF, Morgan TI, Yaar I, Granger CV. Ethylene oxide induced polineuropathy. Arch Neurol 1983, 40:419-421.
8. Freitas MRG, Nascimento OJM, Chimelli L. Polineuropatia devida ao óxido de etileno. Arq Neuro-Psiquiat (São Paulo) 1991, 49:460-464.
9. Gross JA, Haas ML, Swift TR. Ethylene oxide neurotoxicity: report of fourcases and review of the literature. Neurology 1979, 29:978-983.
10. Klawans HL, Stein RW, Tanner CM, Goetz CG. A pure parkinsonian syndrome following acute carbon monoxide intoxication. Arch Neurol 1982, 39:302-304.
11. Kusuhara S, Kanazawa I, Nakanishi T, Egashira T. Ethylene oxide polineuropathy. Neurology 1983, 33:377-380.
12. Langston JW, Ballard P, Tetrad JW, Irwin I. Chronic parkinsonism in humans due to product of meperidine-analog synthesis. Science 1983, 219:979-980.
13. Marchiori PE, Barbosa ER, Scaff M, Nitrini R, Médio AF, Assis JL. Síndrome parkinso-niana em intoxicação por organofosforados. Neurobiologia (Recife) 1984, 47:273-280.
14. Ohnishi A, Inoue N, Yamamoto T, Murai Y, Hori H, Tanaka I, Koga M, Akiyama T. Ethylene neuropathy in rats: exposure to 250 ppm. J Neurol Sci 1986, 74:215-221.
15. Peters HA, Levine RL, Matthews CG, Chapman LJ. Extrapiramidal and other neurologic manifestations associated with carbon disulfide fumigant exposure. Arch Neurol 1988, 45: 537-540.
16. Pezzoli G, Ferrante C, Barbieri S, Zecchinelli A. Parkinsonism due to n-hexane exposure. Lancet 1989, 2:874.
17. Steenland K, Stayner L, Greife A, Halperin W, Hayes R, Hornung R, Nowlin S. Mortality amcng workers exposed to ethylene oxide. N Engl J Med 1991, 324:1402-1407.
18. Tetrad JW, Irnin I, Snow B. Acute and persistent parkinsonism associated with ingestion of a petroleum product mixture. Ann Neurol 1990, 28:296.
19. Windebank AJ, Blexrud MD. Residual ethylene oxide in hollow fiber hemodyalisis units is neurotoxic in vitro. Ann Neurol 1989, 26:63-68.

Parkinsonismo secundário a exposição a óxido de etileno registro de caso

Parkinsonism secondary to ethylene oxide exposure: case report

Publication Dates

Publication in this collection
22 Feb 2011
Date of issue
Dec 1992

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Bagg E, Gatto EM, Micheli F, Fernandez-Pardal MM. Parkinsonismo inducido por n-hexa-nos. VIII Congresso Panamericano de Neurologia. 6-12 de outubro 1991, Montevideo, Uruguay.

[2] 2. Crystal HA, Schaumburg HH, Grober El, Fuld PA, Lipton RB. Cognitive impairment and sensory loss associated with chronic low-level ethylene oxide exposure. Neurology 1988, 38:567-569.

[3] 3. De Poorter MC, Leys D, Godefroy O, De Revek J, Petit H. Carbon monoxide induced parkinsonism: preliminary results of bromocriptine therapy. Rev Neurol (Paris) 1991, 147:399-403.

[4] 4. Estrin WJ, Cavalieri SA, Wald P, Beck CE, Jones JR, Cone JE. Evidence cf neurologic dysfunction related to long-term ethylene oxide exposure. Arch Neurol 1987, 44:1283-1286.

[5] 5. Fahn S. Secondary parkinsonism. In Goldensohn ES, Appel SH (eds) : Scientific Approach to Clinical Neurology. Philadelphia : Lea and Febiger, 1977, p 1159-1189.

[6] 6. Ferraz HB, Bertolucci PHF, Pereira JS, Lima JGC, Andrade LAF. Chronic exposure to the fungicide maneb may produce symptoms and signs of CNS manganese intoxication. Neurology 1988, 38:550-553.

[7] 7. Finelli PF, Morgan TI, Yaar I, Granger CV. Ethylene oxide induced polineuropathy. Arch Neurol 1983, 40:419-421.

[8] 8. Freitas MRG, Nascimento OJM, Chimelli L. Polineuropatia devida ao óxido de etileno. Arq Neuro-Psiquiat (São Paulo) 1991, 49:460-464.

[9] 9. Gross JA, Haas ML, Swift TR. Ethylene oxide neurotoxicity: report of fourcases and review of the literature. Neurology 1979, 29:978-983.

[10] 10. Klawans HL, Stein RW, Tanner CM, Goetz CG. A pure parkinsonian syndrome following acute carbon monoxide intoxication. Arch Neurol 1982, 39:302-304.

[11] 11. Kusuhara S, Kanazawa I, Nakanishi T, Egashira T. Ethylene oxide polineuropathy. Neurology 1983, 33:377-380.

[12] 12. Langston JW, Ballard P, Tetrad JW, Irwin I. Chronic parkinsonism in humans due to product of meperidine-analog synthesis. Science 1983, 219:979-980.

[13] 13. Marchiori PE, Barbosa ER, Scaff M, Nitrini R, Médio AF, Assis JL. Síndrome parkinso-niana em intoxicação por organofosforados. Neurobiologia (Recife) 1984, 47:273-280.

[14] 14. Ohnishi A, Inoue N, Yamamoto T, Murai Y, Hori H, Tanaka I, Koga M, Akiyama T. Ethylene neuropathy in rats: exposure to 250 ppm. J Neurol Sci 1986, 74:215-221.

[15] 15. Peters HA, Levine RL, Matthews CG, Chapman LJ. Extrapiramidal and other neurologic manifestations associated with carbon disulfide fumigant exposure. Arch Neurol 1988, 45: 537-540.

[16] 16. Pezzoli G, Ferrante C, Barbieri S, Zecchinelli A. Parkinsonism due to n-hexane exposure. Lancet 1989, 2:874.

[17] 17. Steenland K, Stayner L, Greife A, Halperin W, Hayes R, Hornung R, Nowlin S. Mortality amcng workers exposed to ethylene oxide. N Engl J Med 1991, 324:1402-1407.

[18] 18. Tetrad JW, Irnin I, Snow B. Acute and persistent parkinsonism associated with ingestion of a petroleum product mixture. Ann Neurol 1990, 28:296.

[19] 19. Windebank AJ, Blexrud MD. Residual ethylene oxide in hollow fiber hemodyalisis units is neurotoxic in vitro. Ann Neurol 1989, 26:63-68.

Brasil

Brasil

Parkinsonism secondary to ethylene oxide exposure

Parkinsonismo secundário a exposição a óxido de etileno registro de caso: case report

Abstracts

Parkinsonismo secundário a exposição a óxido de etileno registro de caso

Publication Dates