Clinical And Neuroimaginal Features In Patients With Toxic Encephalopathy Caused By Occupational Exposure To 1,2-Dichloroethane

Background1,2-Dichloroethane (DCE) is a commonly used industrial solvent. Occupational exposure to DCE may lead to acute DCE toxic encephalopathy.Zhejiang province is one of the fastest developing regions in China with many manufacturing factories such as shoemaking, handicrafts and electronics production in which DCE is commonly used. As a result, there is a high potential for workers to experience occupational exposure to DCE.PurposeTo investigate the clinical and radiological features as well as to improve our knowledge and diagnostic level of toxic encephalopathy caused by occupational exposure to 1,2-Dichloroethane. MethodWe reviewed 5 patients admitted to the department of Neurology in our hospital between January 1st 1998 and June 30th 2009, who were subsequently diagnosed with DCE toxic encephalopathy. The clinical manifestations and imaging features were analyzed.ResultsThe patients' symptoms included headache (5/5,100%), nausea and vomiting (3/5, 60%), dizziness (3/5,60%), generalized myoclonus (1/5,20%), generalized tonicoclonic seizures (1/5,20%), recent amnesia (1/5,20%), and blurred vision (1/5,20%). The results of cranial MR imaging (MRI) and diffusion weighted MR imaging (DWI) showed extensive cytotoxic edema (1/5,20%), and extensive vasogenic edema in the bilateral globus pallidus (4/5,80%), subcortical white matter (WHM) (4/5,80%), and bilateral nuclei dentatus (1/5,20%), or cytotoxic edema in the corpus callosum (1/5, 20%). All patients were treated with steroids and/or mannitol for 3 to 10 weeks and made either a partial or complete recovery.Conclusions1. It was found that DCE toxic encephalopathy was mostly acute and subacute in onset. The most common clinical features were headache, dizziness, nausea and vomiting. Generalized myoclonus and generalized tonicoclonic seizures are also found in the reports.2. Brain edema was the main neuroimaging feature and the cause of intracranial hypertension in patients with DCE toxic encephalopathy. DWI and ADC mapping showed that most of the patients had vasogenic brain edema, while some had cytotoxic edema or mixed edema. 3. Treatment aimed at reducing ICP and alleviating edema should be given promptly. which can leads to a good outcome.