Estudo das manifestações neurológicas em 93 doentes com intoxicação exógena por substancias químicas não medicamentosas

Agapejev, S.; Vassiliev, I.; Lima, M. M. F.

doi:10.1590/S0004-282X1986000300003

Resumos

Foram analisadas as manifestações neurológicas em 93 doentes com suspeita de intoxicação exógena. A detecção das substancias tóxicas foi realizada no sangue, urina e líquido cefalorraqueano. Verificou-se nítido predomínio do comprometimento do sistema nervoso central em relação ao periférico e aparente tropismo de herbicidas e organofosforados para o sistema nervoso central, comparando-se o comportamento dos metais pesados e organoclorados. São analisados os prováveis mecanismos de ação dessas substancias no sistema nervoso e são apresentados os sinais e/ou sintomas que foram observados.

Ninety-three patients with neurological manifestations and suspected exogenous intoxication were analysed. The detection of toxic substances was performed in the blood, urine and cerebrospinal fluid. There was clear predominance of the central nervous system impairment than the peripheric, and an apparent tropism of herbicides and organophosphates to the central nervous system compared with the peripheral nervous system, and considering the manifestations caused by carbamates and organochlorines. The authors analyse some probable action mechanism of these substances in the nervous system, and show the most frequently neurological signs and symptoms found.

Estudo das manifestações neurológicas em 93 doentes com intoxicação exógena por substancias químicas não medicamentosas

Neurologic manifestations in 93 patients with exogenous intoxication by non-medicamentous chemical substances

S. Agapejev^I; I. Vassiliev^II; M. M. F. Lima^III

^IDepartamento de Neurologia e Psiquiatria, Faculdade de Medicina (FMB) - Universidade Estadual Paulista, Campus de Botucatu

^IIDepartamento de Farmacologia, Instituto Básico de Biologia Médica e Agrícola (IBBMA) - Universidade Estadual Paulista, Campus de Botucatu

^IIIAcadêmica, FMB - Universidade Estadual Paulista, Campus de Botucatu

RESUMO

Foram analisadas as manifestações neurológicas em 93 doentes com suspeita de intoxicação exógena. A detecção das substancias tóxicas foi realizada no sangue, urina e líquido cefalorraqueano. Verificou-se nítido predomínio do comprometimento do sistema nervoso central em relação ao periférico e aparente tropismo de herbicidas e organofosforados para o sistema nervoso central, comparando-se o comportamento dos metais pesados e organoclorados. São analisados os prováveis mecanismos de ação dessas substancias no sistema nervoso e são apresentados os sinais e/ou sintomas que foram observados.

SUMMARY

Ninety-three patients with neurological manifestations and suspected exogenous intoxication were analysed. The detection of toxic substances was performed in the blood, urine and cerebrospinal fluid. There was clear predominance of the central nervous system impairment than the peripheric, and an apparent tropism of herbicides and organophosphates to the central nervous system compared with the peripheral nervous system, and considering the manifestations caused by carbamates and organochlorines. The authors analyse some probable action mechanism of these substances in the nervous system, and show the most frequently neurological signs and symptoms found.

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Departamento de Neurologia e Psiquiatria - Faculdade de Medicina de Botucatu, UNESP - 18600 - Botucatu, SP - Brasil.

1. ALDRIDGE, W.N. & BARNES, J.M. - Neurotoxic and biochemical properties of some triaryl phosphates. Biochem. Pharmacol. 6:177, 1961.
2. ALDRIDGE, W.N. & BARNES, J.M. - Further observations on the neurotoxicity of organophosphorus compounds. Biochem. Pharmacol. 15:541, 1966.
3. ALONSO, J.L.; ATALLA, A.; CA VALIERE, M.J.; GAGIOTI, S.M. & LORENTI, M.A.A. - Polineuropatia por Parathion: estudo clínico, eletrofisiológico e histológico de um caso. Arq. Neui'o-Psiquiat. (São Paulo) 41:292, 1983.
4. ALLEN, N.; MENDELL, J.R.; BILLMAIER, D. J.; FONTAIN, R.E. & O'NEILL, J. - Toxic polyneuropathy due to methyl n-buthyl ketone: an industrial outbreak. Arch. Neurol. 32:209, 1975.
5. CAVANAGH, J.B. - Toxic substances and the nervous system. Brit. med. Bull. 25:268, 1969.
6. DILLE, J.R. & SMITH, P.W. - Central nervous system effects of chronic exposure to organophosphate inseticides. Aerosp. Med. 35:475, 1964.
7. DUFFY, F.H.; BURCHFIELD, J.L.; BARTELS, P.H.; GAON, M. & SIM, V.M. - Long-term effects of an organophosphate upon the human electroencephalogram. Toxicol, appl. Pharmacol. 47:161, 1979.
8 ECOBICHON, D.J - Organophosphorus ester inseticides. In D.J. Ecobichor & R.M. Joy: Pesticides and Neurological Diseases. CRC Press Florida, 1982.
9. ECOBICHON, D.J. - Carbamic acid ester pesticide. In D.J. Ecobichon & R.M. Joy: Pesticides and Neurological Dispases. Press Florida, 1982.
10. FORNAZZARI, L. WILKINSON, D.A.; KAPUR, B.M. & CARLEN, P.L. - Cerebelar, cortical and functional impairment in toluene abusers. Acta neurol. scand. 67:319, 1983.
11. GARLAND, T.O. & PATTERSON, M.W.H. - Six cases of acrylamide poisoning. Brit. med. J. 4:134, 1967.
12. HAYMAKER, W.; GINZLER, A.M. & FERGUSSON, R.L. - The toxic effects of prolonged ingestion of DDT on dogs with special reference to lesions in the brain. Amer. J. med. Sci. 212:423, 1946.
13. HAWKINS, R.A. & BIEBUYCK, J.F. - Ketone bodies are selectively used by individual brain regions. Science 205:325. 1979.
14. JOHNSON, M.K. - Delayed neurotoxic action of some organophosphorus compounds, Brit. med. Bull. 25:231, 1969.
15. JOHNSON, M.K. - Irreversible phosphorylation of brain neurotoxic esterase. Monogr. Neurol. Sci. 9:99. Karger, Basel, 1980.
16. JOY, R.M. - Chlorinated hydrocarbon inseticide. In D.J. Ecobichon & R.M. Joy (eds.): Pesticides and Neurological Diseases. CRC Press Florida, 1982.
17. JUNG, H.D. & WOLF, F. - Contact eczemas due to forestry use of the herbicide SELEST 100. Dtsch. Gesundheit. 32:1464. 1977.
18. JUNTUNEN, J.; ANTTI-POIKA, M.; TOLA, S. & PARTANEN, T. - Clinical prognosis of patients with diagnosed chronic solvent intoxication. Acta Neurol, scand. 65:488, 1982.
19. JUNTUNEN, J.; HERNEBERO, S.; EISTOLA, P. & HUPIL, V. - Exposure to industrial solvents and brain atrophy. Eur. Neurol. 19:366, 1980.
20. KLAASSEN, CD. - Absorption, distribution and excretion of toxicants. In J. Doul, CD. Klaassen & M.O. Amdur (eds.): Toxicology: The Basic Science of Poisons. Ed. 2. MacMillan, New York, 1981.
21. MARTINEZ, A.J.; TAYLOR, J.R.; DYCK, P.J.; HOUFF, S.A. & ISAACS, E. - Chlordecone intoxication in man. Neurology 28:631, 1978.
22. MATA, M.; FINK, D.J. & GAINER, H. - Metabolic mapping of functional activity in the hypothalaphysical system of the rat. Science 205:723, 1979.
23. REPKO, J.D. & CORUM, CR. - Avaliação e retrospectiva crítica das seqüelas neurológicas e comportamentais em razão da absorção de chumbo inorgânico. Rev. bras. Saúde ocupac. 12:7, 1984.
24. ROSENBERG, J. - 2,4-dichlorophenoxyacetic acid (2,4-D): evaluation of human health hazards. Hazard Alert System, Epidemiological Studies Laboratory, Berkeley, 1980.
25. SHEA, P.A. & APRISON, M.H. - The distribution of acetyl - CoA in specific areas of the CNS of the rat as measured by a modification of a radio-enzymatic assay for acetylcholine and choline. J. Neurochem. 28:51, 1977.
26. SPENCER, P.S.; SCHAUMBURG, H.H.; RALEIGH, R.L. & TERHAAR, C.J. - Nervous system degeneration produced by the industrial solvent methyl n-butyl ketone. Arch. Neurol. 32:219, 1975.
27. TAYLOR, J.R.; SELHORST, J.B.; HOUFF, S.A. & MARTINEZ, A.J. - Chlordecone intoxication in man. Neurology 28:626, 1978.
28. VESSEL, E. - Why are toxic reactions to drugs so often undetected initially? N. Engl. J. Med. 308:1027, 1980.
29. WERNECK, L.C. & NOVAK, E.M. - Intoxicações por inseticidads: microdissecção de nervos e histoquímica de músculos em 10 casos. Arq. Neuro-Psiquiat. (São Paulo) 37:15, 1979.
³⁰
W.H.O. Publication - Environmental Health-Criteria: 18. Arsenic. International Programe on Chemical Safety. W.H.O., Geneva, 1981.
³¹
W.H.O. Publication - Environmental Health-Criteria 29: 2,4 dichlorophenoxyacetic acid (2,4-D). International Programme on Chemical Safety. W.H.O., Geneva, 1984.
32. ZADTKOFF, CM. - Toxic encephalopathy associated with use of insect repliant. J. Pediatrics 95:140, 1979.

Datas de Publicação

Publicação nesta coleção
29 Jun 2011
Data do Fascículo
Set 1986

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

[1] 1. ALDRIDGE, W.N. & BARNES, J.M. - Neurotoxic and biochemical properties of some triaryl phosphates. Biochem. Pharmacol. 6:177, 1961.

[2] 2. ALDRIDGE, W.N. & BARNES, J.M. - Further observations on the neurotoxicity of organophosphorus compounds. Biochem. Pharmacol. 15:541, 1966.

[3] 3. ALONSO, J.L.; ATALLA, A.; CA VALIERE, M.J.; GAGIOTI, S.M. & LORENTI, M.A.A. - Polineuropatia por Parathion: estudo clínico, eletrofisiológico e histológico de um caso. Arq. Neui'o-Psiquiat. (São Paulo) 41:292, 1983.

[4] 4. ALLEN, N.; MENDELL, J.R.; BILLMAIER, D. J.; FONTAIN, R.E. & O'NEILL, J. - Toxic polyneuropathy due to methyl n-buthyl ketone: an industrial outbreak. Arch. Neurol. 32:209, 1975.

[5] 5. CAVANAGH, J.B. - Toxic substances and the nervous system. Brit. med. Bull. 25:268, 1969.

[6] 6. DILLE, J.R. & SMITH, P.W. - Central nervous system effects of chronic exposure to organophosphate inseticides. Aerosp. Med. 35:475, 1964.

[7] 7. DUFFY, F.H.; BURCHFIELD, J.L.; BARTELS, P.H.; GAON, M. & SIM, V.M. - Long-term effects of an organophosphate upon the human electroencephalogram. Toxicol, appl. Pharmacol. 47:161, 1979.

[8] 8 ECOBICHON, D.J - Organophosphorus ester inseticides. In D.J. Ecobichor & R.M. Joy: Pesticides and Neurological Diseases. CRC Press Florida, 1982.

[9] 9. ECOBICHON, D.J. - Carbamic acid ester pesticide. In D.J. Ecobichon & R.M. Joy: Pesticides and Neurological Dispases. Press Florida, 1982.

[10] 10. FORNAZZARI, L. WILKINSON, D.A.; KAPUR, B.M. & CARLEN, P.L. - Cerebelar, cortical and functional impairment in toluene abusers. Acta neurol. scand. 67:319, 1983.

[11] 11. GARLAND, T.O. & PATTERSON, M.W.H. - Six cases of acrylamide poisoning. Brit. med. J. 4:134, 1967.

[12] 12. HAYMAKER, W.; GINZLER, A.M. & FERGUSSON, R.L. - The toxic effects of prolonged ingestion of DDT on dogs with special reference to lesions in the brain. Amer. J. med. Sci. 212:423, 1946.

[13] 13. HAWKINS, R.A. & BIEBUYCK, J.F. - Ketone bodies are selectively used by individual brain regions. Science 205:325. 1979.

[14] 14. JOHNSON, M.K. - Delayed neurotoxic action of some organophosphorus compounds, Brit. med. Bull. 25:231, 1969.

[15] 15. JOHNSON, M.K. - Irreversible phosphorylation of brain neurotoxic esterase. Monogr. Neurol. Sci. 9:99. Karger, Basel, 1980.

[16] 16. JOY, R.M. - Chlorinated hydrocarbon inseticide. In D.J. Ecobichon & R.M. Joy (eds.): Pesticides and Neurological Diseases. CRC Press Florida, 1982.

[17] 17. JUNG, H.D. & WOLF, F. - Contact eczemas due to forestry use of the herbicide SELEST 100. Dtsch. Gesundheit. 32:1464. 1977.

[18] 18. JUNTUNEN, J.; ANTTI-POIKA, M.; TOLA, S. & PARTANEN, T. - Clinical prognosis of patients with diagnosed chronic solvent intoxication. Acta Neurol, scand. 65:488, 1982.

[19] 19. JUNTUNEN, J.; HERNEBERO, S.; EISTOLA, P. & HUPIL, V. - Exposure to industrial solvents and brain atrophy. Eur. Neurol. 19:366, 1980.

[20] 20. KLAASSEN, CD. - Absorption, distribution and excretion of toxicants. In J. Doul, CD. Klaassen & M.O. Amdur (eds.): Toxicology: The Basic Science of Poisons. Ed. 2. MacMillan, New York, 1981.

[21] 21. MARTINEZ, A.J.; TAYLOR, J.R.; DYCK, P.J.; HOUFF, S.A. & ISAACS, E. - Chlordecone intoxication in man. Neurology 28:631, 1978.

[22] 22. MATA, M.; FINK, D.J. & GAINER, H. - Metabolic mapping of functional activity in the hypothalaphysical system of the rat. Science 205:723, 1979.

[23] 23. REPKO, J.D. & CORUM, CR. - Avaliação e retrospectiva crítica das seqüelas neurológicas e comportamentais em razão da absorção de chumbo inorgânico. Rev. bras. Saúde ocupac. 12:7, 1984.

[24] 24. ROSENBERG, J. - 2,4-dichlorophenoxyacetic acid (2,4-D): evaluation of human health hazards. Hazard Alert System, Epidemiological Studies Laboratory, Berkeley, 1980.

[25] 25. SHEA, P.A. & APRISON, M.H. - The distribution of acetyl - CoA in specific areas of the CNS of the rat as measured by a modification of a radio-enzymatic assay for acetylcholine and choline. J. Neurochem. 28:51, 1977.

[26] 26. SPENCER, P.S.; SCHAUMBURG, H.H.; RALEIGH, R.L. & TERHAAR, C.J. - Nervous system degeneration produced by the industrial solvent methyl n-butyl ketone. Arch. Neurol. 32:219, 1975.

[27] 27. TAYLOR, J.R.; SELHORST, J.B.; HOUFF, S.A. & MARTINEZ, A.J. - Chlordecone intoxication in man. Neurology 28:626, 1978.

[28] 28. VESSEL, E. - Why are toxic reactions to drugs so often undetected initially? N. Engl. J. Med. 308:1027, 1980.

[29] 29. WERNECK, L.C. & NOVAK, E.M. - Intoxicações por inseticidads: microdissecção de nervos e histoquímica de músculos em 10 casos. Arq. Neuro-Psiquiat. (São Paulo) 37:15, 1979.

[30] ³⁰
W.H.O. Publication - Environmental Health-Criteria: 18. Arsenic. International Programe on Chemical Safety. W.H.O., Geneva, 1981.

[31] ³¹
W.H.O. Publication - Environmental Health-Criteria 29: 2,4 dichlorophenoxyacetic acid (2,4-D). International Programme on Chemical Safety. W.H.O., Geneva, 1984.

[32] 32. ZADTKOFF, CM. - Toxic encephalopathy associated with use of insect repliant. J. Pediatrics 95:140, 1979.