Document Detail


Cerebrospinal fluid analysis in fatal thallium poisoning: evidence for delayed distribution into the central nervous system.
MedLine Citation:
PMID:  15166769     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The neurologic manifestations of thallium poisoning include a severely painful ascending peripheral neuropathy, autonomic dysfunction, cranial nerve abnormalities, and a toxic encephalopathy. Although thallium has a short half-life, these neurologic manifestations commonly progress, even as the blood concentration of thallium decreases. This suggests either that thallium persists in neuronal tissues or that it initiates an injury cascade that takes time to fully manifest. As the latter mechanism is consistent with many toxin exposures, the concept of a central nervous system reservoir for thallium is often discounted. A recent case provided a unique opportunity to evaluate this possibility. A 48-year-old man was acutely and chronically thallium poisoned by his common-law wife. During his initial exposures, only gastrointestinal symptoms manifested. Following an acute ingestion, hospitalization was required. Over 3 days, his symptoms rapidly progressed from a severely painful neuropathy to slurred speech, ptosis, confusion, coma, respiratory insufficiency, and death. Because of considerations of alternative diagnoses, 2 lumbar punctures were performed, one on admission and another on the day of his death. Serum thallium concentrations obtained from stored blood samples were paired with spinal fluid concentrations from the same days. On day 1, serum and spinal fluid concentrations were 8700 mu/L and 1200 mu/L, respectively. On day 3, although the serum concentration had fallen to 7200 mu/L, the spinal fluid concentration had increased to 2100 mu/L. This case provides evidence to support the hypothesis that thallium distributes into the central nervous system more slowly than the blood compartment, and this may in part account for the progression of neurologic findings in the setting of decreasing serum concentrations.
Authors:
Adhi N Sharma; Lewis S Nelson; Robert S Hoffman
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  The American journal of forensic medicine and pathology     Volume:  25     ISSN:  0195-7910     ISO Abbreviation:  Am J Forensic Med Pathol     Publication Date:  2004 Jun 
Date Detail:
Created Date:  2004-05-28     Completed Date:  2004-07-22     Revised Date:  2011-02-02    
Medline Journal Info:
Nlm Unique ID:  8108948     Medline TA:  Am J Forensic Med Pathol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  156-8     Citation Subset:  IM    
Affiliation:
New York City Poison Control Center, New York, NY 10016, USA.
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MeSH Terms
Descriptor/Qualifier:
Consciousness Disorders / chemically induced
Humans
Male
Middle Aged
Muscle Weakness / chemically induced
Poisoning / diagnosis
Reflex, Abnormal
Speech Disorders / chemically induced
Spinal Puncture
Thallium / blood,  cerebrospinal fluid*,  poisoning*
Chemical
Reg. No./Substance:
7440-28-0/Thallium

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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