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Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282X

Arq. Neuro-Psiquiatr. vol.50 no.4 São Paulo Dec. 1992

http://dx.doi.org/10.1590/S0004-282X1992000400020 

Parkinsonismo secundário a exposição a óxido de etileno registro de caso

 

Parkinsonism secondary to ethylene oxide exposure: case report

 

 

Egberto R. BarbosaII; Luiz R. ComerlattiII; Monica S. HaddadI; Milberto ScaffIII

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.

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