Even in areas with ostensibly intact myelin there was reactive gliosis (H, GFAP immunohistochemistry, cerebral white matter) and collections of perivascular macrophages (I, LFB-PAS, pons), changes that may foreshadow detectable myelin loss. Laboratory testing for acute toluene toxicity is hampered by the fact that blood tests for toluene and urinary tests for hippuric acid are not available in most hospitals. Ann Neurol. Formal evaluation of neurobehavioral function in one group of such patients documented widespread cognitive dysfunction with neuropsychological measures, including the Wechsler Adult Intelligence Scale (WAIS) and the Wechsler Memory Scale (20). Some early reports of presumed toluene neurotoxicity are difficult to interpret because the patients were acknowledged to abuse multiple solvents and may not have represented neurotoxicity from toluene alone. The damage to brain white matter appears to become irreversible at some point and no treatment is currently known other than abstinence. Long-term and intense exposure to toluene vapors in humans who abuse spray paint and related substances has led to the recognition that toluene has a severe impact on central nervous system myelin. At these sites both endothelial damage and increased neuronal activity result in recruitment of monocytes/macrophages (peripherally) and activation of microglia (centrally), which release mediators that lead to sensitisation of neurons thereby enabling positive feedback that sustains chronic pain. 1997 Jan;72(1):1-7. doi: 10.1006/enrs.1996.3686. Environ Res. He reported wearing latex gloves daily and drinking alcohol occasionally. Biochemical analyses also showed increases in very long chain fatty acids in brain, further mimicking ALD. The cerebral white matter can be readily studied with MRS, and abnormalities of MR spectra have already been noted in many white matter disorders such as MS (39). APF = Assigned Protection Factor. SDS; Triethylaluminum solution. The demyelination was interpreted by the authors as being secondary to the neuronal loss. As the damage gets worse, you will likely lose feeling in your toes, feet, and legs. A Wearable and Wireless Gas-Sensing System Using Flexible Polymer/Multi-Walled Carbon Nanotube Composite Films. Pathophysiology of Toluene Brain Damage. Left untreated, nerve damage may worsen over time. 2F). Inhalants, along with alcohol and marijuana, may serve as the initial substances of abuse for young people (3). Arch Neurol 31:160-167, 1974 Toluene Optic Neuropathy James R. Keane, M D Cerebellar damage associated with exposure to toluene (methyl benzene) has been discussed in this journal by Boor and Hurtig [I]. The brain from both patients showed cerebral atrophy, with weights of 1,100 and 980 grams, respectively. Most inhaled toluene is metabolized in the liver by conversion to benzoic acid by two enzymes, alcohol dehydrogenase and aldehyde dehydrogenase (6).  |  This study was the first to demonstrate that toluene abusers develop a dementia syndrome that directly parallels the degree of white matter damage as demonstrated by neuroimaging (22). CAS Number: 15833-63-3. More than 3 million tons of toluene are produced each year in the United States alone (6), and this solvent is found in many occupational settings and in numerous household products. See also the symptoms of Occupational liver damage -- Toluene and Occupational liver damage -- Toluene: Introduction. This issue is important not only for those individuals with inhalant abuse, but potentially for millions of other persons who are exposed to occupational levels of solvents such as toluene in their workplace or at home (7). Because nerve damage is often progressive, it is important to consult with a doctor when you first notice symptoms. Recent evidence has suggested that defective metabolism of toluene may occur in some individuals because of a deficient gene coding for aldehyde dehydrogenase, one of the hepatic enzymes responsible for metabolizing toluene (6, 8, 49). Binswanger's disease: Case presentation and differential diagnosis. There are many surgical as well as non-surgical techniques for treating damaged nerve, which has been practiced since long in medical science. NLM Environ Res. Toluene abusers generally employ one of two methods to achieve a “high” with this substance: “huffing,” in which a rag is soaked with toluene and the fumes are directly inhaled, and “bagging,” in which the fumes are inhaled as they arise from the solvent placed in a plastic bag. People “huff” or “sniff” paint, paint thinner, or glue in order … 2019 Dec;179(Pt B):108834. doi: 10.1016/j.envres.2019.108834. Female reproductive system damage and pregnancy loss . Recommendations apply only to National Institute for Occupational Safety and Health (NIOSH) approved respirators. The nerve damage made controlling her tongue difficult and some sounds impossible to make correctly. Nerve damage may cause loss of sensation or numbness in the fingertips, making it harder to do things with your hands. Other investigators have focused more on alterations in astrocytes than on neuronal populations (57, 58). In an autopsy study of a patient who inhaled toluene prior to death, tissue concentrations were minimal in the cerebral cortex and hippocampus and were highest in the corpus callosum, the largest white matter tract in the brain (42). Peripheral neuropathy may be caused by a number of different medical conditions, such as diabetes and cancer. Fibrillation is present and the injury usually requires surgery (Figure 13). Hence, there are major obstacles to documenting the exact duration of toluene abuse, the levels of exposure, and even the coexistent abuse of other volatile or non-volatile substances. This site needs JavaScript to work properly. Your skin will also become numb. His autopsy findings, coupled with MRI data, were the first to confirm that the brunt of the toxic damage from toluene is directed toward the CNS white matter. In rat brain, toluene inhalation appears to activate astrocytes, with enhancement of GFAP immunoreactivity (59). Similarly, using rats with inhalation exposure to toluene, Korbo et al found neuronal loss in the hippocampus but only studied this single neuroanatomic site (54). He urged quick action in the event of an injury to ensure no lasting damage to the nerve. These results suggested a primary impact on sustained attention, speed of information processing and visuospatial skills, combined with relative sparing of language (23), a pattern consistent with previous neurobehavioral observations in toluene abuse (21). Overall drug abuse among teenagers has declined in the past several years, but inhalant abuse is on the rise. Neil made major contributions to the field of neurotoxicology, particularly toluene abuse, and will be greatly missed. N-hexane is a known axonal toxin (46, 47), and could have accounted for the axonal loss. In the UK it's estimated almost 1 in 10 people aged 55 or over are affected by peripheral neuropathy. Toluene is retained somewhat longer in adipose tissue, where its half-life is 0.5 to 3 days (9). A series of 20 individuals with chronic solvent vapor abuse from toluene demonstrated the use of computerized tomography (CT) to investigate brain structural abnormalities (21). Many of our patients have inhaled these vapors for decades, and it is not uncommon to see 50- and 60-year-old individuals still engaged in this dangerous practice. As mentioned, this solvent, like many others, is highly lipophilic (1), and in laboratory animals toluene is preferentially distributed in lipid-rich regions of the brain (51). Case 1 was a 33-year-old man with a history of paint and glue sniffing since age 11, and Case 2 was a 41-year-old woman who had been addicted to paint sniffing for at least 9 years and died while inhaling paint fumes and drinking alcohol. A variety of unusual brainstem signs were noted in some patients, including opsoclonus, ocular flutter, and ocular dysmetria (19). At autopsy the brain showed cerebral and cerebellar atrophy and severe thinning of the corpus callosum. Hearing loss and cleft palate may also be seen (66). She was a known substance abuser and had been described as often being intoxicated and “smelling of glue.” Neither detailed neurological examinations nor neuroimaging were performed in life and she died by hanging. Complementary to the human clinical data, several animal studies have verified that toluene targets the central, not peripheral, nervous system. Văcăraș V, Cordoș AM, Rahovan I, Frunze S, Mureșanu DF. Advanced neuroimaging techniques such as diffusion tensor imaging, magnetization transfer imaging, and magnetic resonance spectroscopy promise to improve the early recognition of leukoencephalopathy in individuals exposed to toluene when the potential for reversibility is maximal. 46, 47 ), and the cerebellar white matter ( 43 ) showed excellent neuronal preservation ( D.. Microscopy of Case 1, toluene nerve damage fast blue-periodic acid-Schiff ( LFB-PAS ) staining showed severe myelin loss ( Fig as! 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