Diagnostic Considerations

Additional conditions to consider include the following:

Acute CNS symptoms (rapid onset)
Cerebral anoxia
Cerebral ischemia
Drug overdose
Drug toxicity
Hyperglycemia or hypoglycemia
Metabolic derangements
Postictal
Thyroid storm
Wernicke encephalopathy
Meningitis
Encephalitis
Central pontine myelinolysis Chronic CNS symptoms (slow onset)
Pseudodementia (depression)
Dementia of Alzheimer type
Dementia of multiinfarct type
Dementia of normal pressure hydrocephalus (NPH) variant
Dementia pugilistica
Drug toxicity
Nutritional excess of deficit
Multiple sclerosis
Epilepsy
Brain tumor or metastasis
Carcinomatous meningitis
Encephalitis or meningitis
Chronic drug abuse
Multiple head trauma history
Hepatocerebral syndrome
Krabbe leukodystrophy
Adult adrenoleukodystrophy Chronic PNS symptoms
Diabetes
Thyroid disease
Uremia
Liver disease
HIV infection
Medication toxicity
Lymphoma or other neoplasm
Nutritional deficit or excess
Syphilis
Familial neuropathy
Myasthenia gravis
Amyotrophic lateral sclerosis
Mononeuritis multiplex Other diagnoses to consider
Occupational exposures from previous employment
Environmental exposures from residence (indoor) and neighborhood (ambient) air and household water
Other environmental exposures from commercial products routinely used
Exposures from food and food preservatives
Paraproteinemic neuropathy

Differential Diagnoses

Workup

Aschengrau A, Janulewicz PA, White RF, Vieira VM, Gallagher LG, Getz KD, et al. Long-term Neurotoxic Effects of Early-life Exposure to Tetrachloroethylene-contaminated Drinking Water. Ann Glob Health. 2016 Jan-Feb. 82 (1):169-79. [QxMD MEDLINE Link].
Orsi L, Monnereau A, Dananche B, Berthou C, Fenaux P, Marit G, et al. Occupational exposure to organic solvents and lymphoid neoplasms in men: results of a French case-control study. Occup Environ Med. 2010 Oct. 67(10):664-72. [QxMD MEDLINE Link].
Gargouri I, Khadhraoui M, Nisse C, Leroyer A, Masmoudi ML, Frimat P, et al. A case study on co-exposure to a mixture of organic solvents in a Tunisian adhesive-producing company. J Occup Med Toxicol. 2011 Nov 14. 6:28. [QxMD MEDLINE Link]. [Full Text].
Fatal exposure to methylene chloride among bathtub refinishers - United States, 2000-2011. MMWR Morb Mortal Wkly Rep. 2012 Feb 24. 61(7):119-22. [QxMD MEDLINE Link].
Page EH, Pajeau AK, Arnold TC, et al. Peripheral neuropathy in workers exposed to nitromethane. Am J Ind Med. 2001 Jul. 40(1):107-13. [QxMD MEDLINE Link].
Feldman RG, Ratner MH, Ptak T. Chronic toxic encephalopathy in a painter exposed to mixed solvents. Environ Health Perspect. 1999 May. 107(5):417-22. [QxMD MEDLINE Link].
Bates MN, Reed BR, Liu S, Eisen EA, Hammond SK. Solvent exposure and cognitive function in automotive technicians. Neurotoxicology. 2016 Dec. 57:22-30. [QxMD MEDLINE Link].
Kelsall H, Macdonell R, Sim M, et al. Neurological status of Australian veterans of the 1991 Gulf War and the effectof medical and chemical exposures. Int J Epidemiol. 2005 Aug. 34(4):810-9. [QxMD MEDLINE Link].
Longstreth WT. Central nervous system disorders, neurological and psychological disorders. Rosenstock L, Cullen MR, eds. Textbook of Clinical, Occupational and Environmental Medicine. Philadelphia, PA: WB Saunders; 1994.
LaDou J. Approach to the diagnosis of the occupational illness. LaDou J, ed. Occupational and Environmental Medicine. Lange Medical. 2nd ed. New York, NY: McGraw-Hill Professional; 1997.
Min YS, Ahn YS. Central nervous system diseases of organic solvents exposed workers based on nationwide medical surveillance-data in Korea. Am J Ind Med. 2016 May. 59 (5):392-8. [QxMD MEDLINE Link].
Hanley KW, Petersen MR, Cheever KL, Luo L. Bromide and N-acetyl-S-(n-propyl)-L-cysteine in urine from workers exposed to 1-bromopropane solvents from vapor degreasing or adhesive manufacturing. Int Arch Occup Environ Health. 2010 Jun. 83(5):571-84. [QxMD MEDLINE Link].
Hanley KW, Petersen MR, Cheever KL, Luo L. N-acetyl-S-(n-propyl)-l-cysteine in urine from workers exposed to 1-bromopropane in foam cushion spray adhesives. Ann Occup Hyg. 2009 Oct. 53(7):759-69. [QxMD MEDLINE Link].
Majersik JJ, Caravati EM, Steffens JD. Severe neurotoxicity associated with exposure to the solvent 1-bromopropane (n-propyl bromide). Clin Toxicol (Phila). 2007. 45(3):270-6. [QxMD MEDLINE Link].
Sclar G. Encephalomyeloradiculoneuropathy following exposure to an industrial solvent. Clin Neurol Neurosurg. 1999 Sep. 101(3):199-202. [QxMD MEDLINE Link].
Pezzoli G, Strada O, Silani V, Zecchinelli A, Perbellini L, Javoy-Agid F. Clinical and pathological features in hydrocarbon-induced parkinsonism. Ann Neurol. 1996 Dec. 40(6):922-5. [QxMD MEDLINE Link].
McCrank E, Rabheru K. Four cases of progressive supranuclear palsy in patients exposed to organic solvents. Can J Psychiatry. 1989 Dec. 34(9):934-6. [QxMD MEDLINE Link].
Tetrud JW, Langston JW, Irwin I, Snow B. Parkinsonism caused by petroleum waste ingestion. Neurology. 1994 Jun. 44(6):1051-4. [QxMD MEDLINE Link].
Uitti RJ, Snow BJ, Shinotoh H, Vingerhoets FJ, Hayward M, Hashimoto S. Parkinsonism induced by solvent abuse. Ann Neurol. 1994 May. 35(5):616-9. [QxMD MEDLINE Link].
Langston JW, Ballard P, Tetrud JW, Irwin I. Chronic Parkinsonism in humans due to a product of meperidine-analog synthesis. Science. 1983 Feb 25. 219(4587):979-80. [QxMD MEDLINE Link].
Gash DM, Rutland K, Hudson NL, Sullivan PG, Bing G, Cass WA, et al. Trichloroethylene: Parkinsonism and complex 1 mitochondrial neurotoxicity. Ann Neurol. 2008 Feb. 63(2):184-92. [QxMD MEDLINE Link].
Guehl D, Bezard E, Dovero S, Boraud T, Bioulac B, Gross C. Trichloroethylene and parkinsonism: a human and experimental observation. Eur J Neurol. 1999 Sep. 6(5):609-11. [QxMD MEDLINE Link].
Kochen W. the endogenous formation of highly chlorinated tetr-beta- carbolines as a possible causative mechanism in idiopathic Parkinson's disease. Advances in Experimental Medicine and Biology. 2003. 527:253-63.
Liu M, Choi DY, Hunter RL, Pandya JD, Cass WA, Sullivan PG. Trichloroethylene induces dopaminergic neurodegeneration in Fisher 344 rats. J Neurochem. 2010 Feb. 112(3):773-83. [QxMD MEDLINE Link].
Goldman SM, Quinlan PJ, Ross GW, Marras C, Meng C, Bhudhikanok GS. Solvent exposures and Parkinson disease risk in twins. Ann Neurol. 2012 Jun. 71(6):776-84. [QxMD MEDLINE Link].
Mattia CJ, Adams JD Jr, Bondy SC. Free radical induction in the brain and liver by products of toluene catabolism. Biochem Pharmacol. 1993 Jul 6. 46(1):103-10. [QxMD MEDLINE Link].
American Conference of Governmental Industrial Hygienists (ACGIH). American Conference of Governmental Industrial Hygienists. Threshold Limit Values and Biological Exposure Indices. 1999.
Current Intelligence Bulletin 48. Organic solvent neurotoxicity. March 31, 1987. National Institute for Occupational Safety and Health (NIOSH). Available at http://www.cdc.gov/niosh/87104_48.html..
Aaserud O, Hommeren OJ, Tvedt B, Nakstad P, Mowé G, Efskind J, et al. Carbon disulfide exposure and neurotoxic sequelae among viscose rayon workers. Am J Ind Med. 1990. 18(1):25-37. [QxMD MEDLINE Link].
Fontenot AP, Pelak VS. Development of neurologic symptoms in a 26-year-old woman following recovery from methanol intoxication. Chest. 2002 Oct. 122(4):1436-9. [QxMD MEDLINE Link].
Aydin K, Sencer S, Demir T, Ogel K, Tunaci A, Minareci O. Cranial MR findings in chronic toluene abuse by inhalation. AJNR Am J Neuroradiol. 2002 Aug. 23(7):1173-9. [QxMD MEDLINE Link].
Finkelstein Y, Vardi J. Progressive parkinsonism in a young experimental physicist following long-term exposure to methanol. Neurotoxicology. 2002 Oct. 23(4-5):521-5. [QxMD MEDLINE Link].
Callender TJ, Morrow L, Subramanian K, Duhon D, Ristovv M. Three-dimensional brain metabolic imaging in patients with toxic encephalopathy. Environ Res. 1993 Feb. 60(2):295-319. [QxMD MEDLINE Link].
Gross JA, Haas ML, Swift TR. Ethylene oxide neurotoxicity: report of four cases and review of the literature. Neurology. 1979 Jul. 29(7):978-83. [QxMD MEDLINE Link].
Ruijten MW, Sallé HJ, Verberk MM. Verification of effects on the nervous system of low level occupational exposure to CS2. Br J Ind Med. 1993 Apr. 50(4):301-7. [QxMD MEDLINE Link]. [Full Text].
Johnson BL, Boyd J, Burg JR, Lee ST, Xintaras C, Albright BE. Effects on the peripheral nervous system of workers' exposure to carbon disulfide. Neurotoxicology. 1983 Spring. 4(1):53-65. [QxMD MEDLINE Link].
Chen JK, Wu MS, Yang CW, Huang JY, Hsu PY, Lin CL, et al. Guillain-Barré syndrome associated with minimal change glomerulopathy and tubular dysfunction - related to acetone-based organic solvent?. Am J Nephrol. 2002 Sep-Dec. 22(5-6):560-5. [QxMD MEDLINE Link].
Jovanic JM, Jovanovich MM, Spasic MJ. Peripheral nerve conduction study in workers exposed to a mixture of organic solvents in the paint and lacquer industry. Croat Med J. 2004. 45:769-74.
Feldman RG. The Vulnerable Brain and Environmental Risks. Isaacson RL, Jensen KF, eds. Neurotoxic effects of trichloroethylene in drinking water. New York, NY: Plenum; 1994. Vol 3: Toxins in Air and Water.
Lee CR, Jeong KS, Kim Y, Yoo CI, Lee JH, Choi YH. Neurobehavioral changes of shipyard painters exposed to mixed organic solvents. Ind Health. 2005 Apr. 43(2):320-6. [QxMD MEDLINE Link].
Rosenberg NL, Grigsby J, Dreisbach J, Busenbark D, Grigsby P. Neuropsychologic impairment and MRI abnormalities associated with chronic solvent abuse. J Toxicol Clin Toxicol. 2002. 40(1):21-34. [QxMD MEDLINE Link].
Kuzuhara S, Kanazawa I, Nakanishi T, Egashira T. Ethylene oxide polyneuropathy. Neurology. 1983 Mar. 33(3):377-80. [QxMD MEDLINE Link].
Gottfried MR, Graham DG, Morgan M, Casey HW, Bus JS. The morphology of carbon disulfide neurotoxicity. Neurotoxicology. 1985 Winter. 6(4):89-96. [QxMD MEDLINE Link].
Lacerda EM, Lima MG, Rodrigues AR, Teixeira CE, de Lima LJ, Ventura DF, et al. Psychophysical evaluation of achromatic and chromatic vision of workers chronically exposed to organic solvents. J Environ Public Health. 2012. 2012:784390. [QxMD MEDLINE Link]. [Full Text].
Beckman S, Eisen EA, Bates MN, Liu S, Haegerstrom-Portnoy G, Hammond SK. Acquired Color Vision Defects and Hexane Exposure: A Study of San Francisco Bay Area Automotive Mechanics. Am J Epidemiol. 2016 Jun 1. 183 (11):969-76. [QxMD MEDLINE Link].
Sugimoto K, Goto S, Kanda S, Taniguchi H, Nakamura K, Baba T. Studies on angiopathy due to carbon disulfide. Retinopathy and index of exposure dosages. Scand J Work Environ Health. 1978 Jun. 4(2):151-8. [QxMD MEDLINE Link].
Karai I, Sugimoto K, Goto S. A case comparison study of carbon disulfide retinopathy and diabetic retinopathy using fluorescein fundus angiography. Acta Ophthalmol (Copenh). 1983 Dec. 61(6):1074-86. [QxMD MEDLINE Link].
Vaktskjold A, Talykova LV, Nieboer E. Congenital anomalies in newborns to women employed in jobs with frequent exposure to organic solvents--a register-based prospective study. BMC Pregnancy Childbirth. 2011 Oct 27. 11:83. [QxMD MEDLINE Link]. [Full Text].
Iregren A. Effects on human performance from acute and chronic exposure to organic solvents: a short review. Toxicology. 1988 May. 49(2-3):349-58. [QxMD MEDLINE Link].
Bolla K, Roca R. Occupational Neurology and Clinical Neurotoxicology. Bleeker ML, Hansen JA, eds. Neuropsychiatric sequelae of occupational exposure to neurotoxins. Baltimore, MD: Lippincott Williams and Wilkins; 1994.
Cassitto MG. Vinken and Bruyn's Handbook of Clinical Neurology Part I. de Wolff FA, ed. Organic solvents and the nervous system. Amsterdam, the Netherlands: Elsevier; 1994. Intoxications of the Nervous System.
Dick RB. Handbook of Neurotoxicology. Chang LW, ed. Neurobehavioral assessment of occupationally relevant solvents and chemicals in humans. New York, NY: Marcel Dekker; 1995.
Rosenberg NL. Occupational and Environmental Neurology. Rosenberg NL, ed. Neurotoxicity of organic solvents. Boston, MA: Butterworth-Heinman; 1995.
White RF, Proctor SP. Approaches and Methods. Chang L, ed. Clinico-neuropsychological assessment methods in behavioral neurotoxicology. San Diego, CA: Academic Press; 1995: Neurotoxicology.
Fiedler N. Neuropsychological approaches for the detection and evaluation of toxic symptoms. Environ Health Perspect. 1996 Apr. 104 Suppl 2:239-45. [QxMD MEDLINE Link]. [Full Text].
. Centers for Disease Control and Prevention. n-Hexane-related peripheral neuropathy among automotive technicians--California, 1999-2000. MMWR Morb Mortal Wkly Rep. 2001 Nov 16. 50(45):1011-3. [QxMD MEDLINE Link].
3rd Industrial and Environmental Neurology Congress. Prague 25-28th June 1979 [abstracts]. Act Nerv Super (Praha). 1979 Dec. 21(4):244-303. [QxMD MEDLINE Link].
Altmann L, Böttger A, Wiegand H. Neurophysiological and psychophysical measurements reveal effects of acute low-level organic solvent exposure in humans. Int Arch Occup Environ Health. 1990. 62(7):493-9. [QxMD MEDLINE Link].
Altmann L, Neuhann HF, Krämer U, Witten J, Jermann E. Neurobehavioral and neurophysiological outcome of chronic low-level tetrachloroethene exposure measured in neighborhoods of dry cleaning shops. Environ Res. 1995 May. 69(2):83-9. [QxMD MEDLINE Link].
Astrand I. Uptake of solvents in the blood and tissues of man. A review. Scand J Work Environ Health. 1975 Dec. 1(4):199-218. [QxMD MEDLINE Link].
Barret L, Torch S, Usson Y, Gonthier B, Saxod R. A morphometric evaluation of the effects of trichloroethylene and dichloroacetylene on the rat mental nerve. Preliminary results. Neurosci Lett. 1991 Oct 14. 131(2):141-44. [QxMD MEDLINE Link].
Behese F, Buchtal F. Alcoholic neuropathy: clinical, electrophysiological and biopsy findings. Annals of Neurology. 1977. 2:95.
Broadwell DK, Darcey DJ, Hudnell HK, Otto DA, Boyes WK. Work-site clinical and neurobehavioral assessment of solvent-exposed microelectronics workers. Am J Ind Med. 1995 May. 27(5):677-98. [QxMD MEDLINE Link].
Cavalleri A, Gobba F, Paltrinieri M, Fantuzzi G, Righi E, Aggazzotti G. Perchloroethylene exposure can induce colour vision loss. Neurosci Lett. 1994 Sep 26. 179(1-2):162-6. [QxMD MEDLINE Link].
Cherry N, Gautrin D. Neurotoxic effects of styrene: further evidence. Br J Ind Med. 1990 Jan. 47(1):29-37. [QxMD MEDLINE Link]. [Full Text].
Corsi G, Maestrelli P, Picotti G, Manzoni S, Negrin P. Chronic peripheral neuropathy in workers with previous exposure to carbon disulphide. Br J Ind Med. 1983 May. 40(2):209-11. [QxMD MEDLINE Link]. [Full Text].
Eisenberg J, Ramsey J. Evaluation of 1-Bromopropane Use in Four New Jersey Commercial Dry Cleaning Facilities75-3111New Jersey Department of Health and Senior Services. Health Hazard Evaluation Report. 2010.
Feldman RG. Neurotoxicology. Feldman RG. Recognizing the chemically exposed person and approach to diagnosis. Philadelphia, PA: Lippincott Raven; 1999.
Feldman RG, Lessell S. Progress in Neuroophthalmology. Neuroophthalmological aspects of trichloroethylene intoxication. Brunette J, ed. Amsterdam, Netherlands: 1969.
Feldman RG, Niles C, Proctor SP, Jabre J. Blink reflex measurement of effects of trichloroethylene exposure on the trigeminal nerve. Muscle Nerve. 1992 Apr. 15(4):490-5. [QxMD MEDLINE Link].
Filley CM, Heaton RK, Rosenberg NL. White matter dementia in chronic toluene abuse. Neurology. 1990 Mar. 40(3 Pt 1):532-4. [QxMD MEDLINE Link].
Fornazzari L, Wilkinson DA, Kapur BM, Carlen PL. Cerebellar, cortical and functional impairment in toluene abusers. Acta Neurol Scand. 1983 Jun. 67(6):319-29. [QxMD MEDLINE Link].
Freed DM, Kandel E. Long-term occupational exposure and the diagnosis of dementia. Neurotoxicology. 1988 Fall. 9(3):391-400. [QxMD MEDLINE Link].
Frumkin H. Multiple system atrophy following chronic carbon disulfide exposure. Environ Health Perspect. 1998 Sep. 106(9):611-3. [QxMD MEDLINE Link]. [Full Text].
Garnier R, Bédouin J, Pépin G, Gaillard Y. Coin-operated dry cleaning machines may be responsible for acute tetrachloroethylene poisoning: report of 26 cases including one death. J Toxicol Clin Toxicol. 1996. 34(2):191-7. [QxMD MEDLINE Link].
Gobba F, Galassi C, Imbriani M, Ghittori S, Candela S, Cavalleri A. Acquired dyschromatopsia among styrene-exposed workers. J Occup Med. 1991 Jul. 33(7):761-5. [QxMD MEDLINE Link].
Graham DG, Amarnath V, Valentine WM, Pyle SJ, Anthony DC. Pathogenetic studies of hexane and carbon disulfide neurotoxicity. Crit Rev Toxicol. 1995. 25(2):91-112. [QxMD MEDLINE Link].
Herd PA, Martin HF. Effect of 1,1,1-trichloroethane on mitochondrial metabolism. Biochem Pharmacol. 1975 Jun 15. 24(11-12):1179-85. [QxMD MEDLINE Link].
Hormes JT, Filley CM, Rosenberg NL. Neurologic sequelae of chronic solvent vapor abuse. Neurology. 1986 May. 36(5):698-702. [QxMD MEDLINE Link].
Ichihara G, Li W, Shibata E, Ding X, Wang H, Liang Y, et al. Neurologic abnormalities in workers of a 1-bromopropane factory. Environ Health Perspect. 2004 Sep. 112(13):1319-25. [QxMD MEDLINE Link]. [Full Text].
Ikeda M. Public health problems of organic solvents. Toxicol Lett. 1992 Dec. 64-65 Spec No:191-201. [QxMD MEDLINE Link].
Juntunen J, Hernberg S, Eistola P, Hupli V. Exposure to industrial solvents and brain atrophy. A retrospective study of pneumoencephalographic findings among 37 patients with exposure to industrial solvents. Eur Neurol. 1980. 19(6):366-75. [QxMD MEDLINE Link].
Keane JR. Toluene optic neuropathy. Ann Neurol. 1978 Oct. 4(4):390. [QxMD MEDLINE Link].
Kyrklund T, Kjellstrand P, Haglid KG. Lipid composition and fatty acid pattern of the gerbil brain after exposure to perchloroethylene. Arch Toxicol. 1987 Jul. 60(5):397-400. [QxMD MEDLINE Link].
Landrigan PJ, Kominsky JR, Stein GF, Ruhe RL, Watanabe AS. Common-source community and industrial exposure to trichloroethylene. Arch Environ Health. 1987 Nov-Dec. 42(6):327-32. [QxMD MEDLINE Link].
Li W, Shibata E, Zhou Z, Ichihara S, Wang H, Wang Q. Dose-dependent neurologic abnormalities in workers exposed to 1-bromopropane. J Occup Environ Med. 2010 Aug. 52(8):769-77. [QxMD MEDLINE Link].
Lilis R, Lorimer WV, Diamond S, Selikoff IJ. Neurotoxicity of styrene in production and polymerization workers. Environ Res. 1978 Feb. 15(1):133-8. [QxMD MEDLINE Link].
Logue JN, Stroman RM, Reid D, Hayes CW, Sivarajah K. Investigation of potential health effects associated with well water chemical contamination in Londonderry Township, Pennsylvania, U.S.A. Arch Environ Health. 1985 May-Jun. 40(3):155-60. [QxMD MEDLINE Link].
Majersik JJ, Caravati EM, Steffens JD. Severe neurotoxicity associated with exposure to the solvent 1-bromopropane (n-propyl bromide). Clin Toxicol (Phila). 2007. 45(3):270-6. [QxMD MEDLINE Link].
Matsuoka M, Igisu H, Inoue N, Hori H, Tanaka I. Inhibition of creatine kinase activity by ethylene oxide. Br J Ind Med. 1990 Jan. 47(1):44-7. [QxMD MEDLINE Link]. [Full Text].
McKenna MJ, DiStefano V. Carbon disulfide. I. The metabolism of inhaled carbon disulfide in the rat. J Pharmacol Exp Ther. 1977 Aug. 202(2):245-52. [QxMD MEDLINE Link].
Mergler D, Blain L. Assessing color vision loss among solvent-exposed workers. Am J Ind Med. 1987. 12(2):195-203. [QxMD MEDLINE Link].
Mergler D, Huel G, Bowler R, Frenette B, Cone J. Visual dysfunction among former microelectronics assembly workers. Arch Environ Health. 1991 Nov-Dec. 46(6):326-34. [QxMD MEDLINE Link].
Monforte R, Estruch R, Valls-Solé J, Nicolás J, Villalta J, Urbano-Marquez A. Autonomic and peripheral neuropathies in patients with chronic alcoholism. A dose-related toxic effect of alcohol. Arch Neurol. 1995 Jan. 52(1):45-51. [QxMD MEDLINE Link].
Moslen MT, Reynolds ES, Szabo S. Enhancement of the metabolism and hepatotoxicity of trichloroethylene and perchloroethylene. Biochem Pharmacol. 1977 Mar 1. 26(5):369-75. [QxMD MEDLINE Link].
Patel JM, Harper C, Drew RT. The biotransformation of p-xylene to a toxic aldehyde. Drug Metab Dispos. 1978 Jul-Aug. 6(4):368-74. [QxMD MEDLINE Link].
Pezzoli G, Canesi M, Antonini A, Righini A, Perbellini L, Barichella M. Hydrocarbon exposure and Parkinson's disease. Neurology. 2000 Sep 12. 55(5):667-73. [QxMD MEDLINE Link].
Raitta C, Teir H, Tolonen M, Nurminen M, Helpiö E, Malmström S. Impaired color discrimination among viscose rayon workers exposed to carbon disulfide. J Occup Med. 1981 Mar. 23(3):189-92. [QxMD MEDLINE Link].
Raymond LW, Ford MD. Severe illness in furniture makers using a new glue: 1-bromopropane toxicity confounded by arsenic. J Occup Environ Med. 2007 Sep. 49(9):1009-19. [QxMD MEDLINE Link].
Rosenberg J, Cone J, Katz E. Occupational and Environmental Medicine. .LaDou J, ed. Solvents. Lange Medical 2nd ed. New York, NY: McGraw-Hill Professional; 1997.
Rosén I, Haeger-Aronsen B, Rehnström S, Welinder H. Neurophysiological observations after chronic styrene exposure. Scand J Work Environ Health. 1978. 4 Suppl 2:184-94. [QxMD MEDLINE Link].
Ruijten MW, Hooisma J, Brons JT, Habets CE, Emmen HH, Muijser H. Neurobehavioral effects of long-term exposure to xylene and mixed organic solvents in shipyard spray painters. Neurotoxicology. 1994 Fall. 15(3):613-20. [QxMD MEDLINE Link].
Samukawa M, Ichihara G, Oka N, Kusunoki S. A case of severe neurotoxicity associated with exposure to 1-bromopropane, an alternative to ozone-depleting or global-warming solvents. Arch Intern Med. 2012 Sep 10. 172(16):1257-60. [QxMD MEDLINE Link].
Savic SM. Influence of carbon disulfide on the eye. Arch Environ Health. 1967 Feb. 14(2):325-6. [QxMD MEDLINE Link].
Schaumburg HH, Spencer PS. Environmental hydrocarbons produce degeneration in cat hypothalamus and optic tract. Science. 1978 Jan 13. 199(4325):199-200. [QxMD MEDLINE Link].
Schröder JM, Hoheneck M, Weis J, Deist H. Ethylene oxide polyneuropathy: clinical follow-up study with morphometric and electron microscopic findings in a sural nerve biopsy. J Neurol. 1985. 232(2):83-90. [QxMD MEDLINE Link].
Seppäläinen AM. Neurotoxicity of styrene in occupational and experimental exposure. Scand J Work Environ Health. 1978. 4 Suppl 2:181-3. [QxMD MEDLINE Link].
Seppäläinen AM, Antti-Poika M. Time course of electrophysiological findings for patients with solvent poisoning. A descriptive study. Scand J Work Environ Health. 1983 Feb. 9(1):15-24. [QxMD MEDLINE Link].
Seppäläinen AM, Husman K, Mårtenson C. Neurophysiological effects of long-term exposure to a mixture of organic solvents. Scand J Work Environ Health. 1978 Dec. 4(4):304-14. [QxMD MEDLINE Link].
Seppäläinen AM, Laine A, Salmi T, Verkkala E, Riihimäki V, Luukkonen R. Electroencephalographic findings during experimental human exposure to m-xylene. Arch Environ Health. 1991 Jan-Feb. 46(1):16-24. [QxMD MEDLINE Link].
Seppäläinen AM, Lindström K, Martelin T. Neurophysiological and psychological picture of solvent poisoning. Am J Ind Med. 1980. 1(1):31-42. [QxMD MEDLINE Link].
Seppäläinen AM, Raitta C, Huuskonen MS. n-Hexane-induced changes in visual evoked potentials and electroretinograms of industrial workers. Electroencephalogr Clin Neurophysiol. 1979 Oct. 47(4):492-8. [QxMD MEDLINE Link].
Snyder RS, Andrews LS. Klassen’sCasarett and Doull’s Toxicology. Toxic effects of solvents and vapors. 5th ed. McGraw-Hill: 1996.
So Y. Occupational and Environmental Medicine. LaDou J, ed. Neurotoxicology. 2nd ed. Lange: 1997.
St Clair MB, Anthony DC, Wikstrand CJ, Graham DG. Neurofilament protein crosslinking in gamma-diketone neuropathy: in vitro and in vivo studies using the seaworm myxicola infundibulum. Neurotoxicology. 1989 Winter. 10(4):743-56. [QxMD MEDLINE Link].
Stanosz S, Kuligowski D, Pieleszek A, Zuk E, Rzechula D, Chlubek D. Concentration of dopamine in plasma, activity of dopamine beta-hydroxylase in serum and urinary excretion of free catecholamines and vanillylmandelic acid in women chronically exposed to carbon disulphide. Int J Occup Med Environ Health. 1994. 7(3):257-61. [QxMD MEDLINE Link].
Suwanlaong K, Phanthumchinda K. Neurological manifestation of methyl bromide intoxication. J Med Assoc Thai. 2008 Mar. 91(3):421-6. [QxMD MEDLINE Link].
Urban P, Lukás E. Visual evoked potentials in rotogravure printers exposed to toluene. Br J Ind Med. 1990 Dec. 47(12):819-23. [QxMD MEDLINE Link]. [Full Text].
Vrca A, Bozicevic D, Karacic V, Fuchs R, Prpic-Majic D, Malinar M. Visual evoked potentials in individuals exposed to long-term low concentrations of toluene. Arch Toxicol. 1995. 69(5):337-40. [QxMD MEDLINE Link].
Wegman DH, Levy BS, Halperin WE. Occupational Health. Levy BS, Wegman DH, eds. Recognizing occupational disease. 3rd ed. Boston, MA: Little Brown & Company; 1994.
Williams JM, Howe NR. Benzyl alcohol attenuates the pain of lidocaine injections and prolongs anesthesia. J Dermatol Surg Oncol. 1994 Nov. 20(11):730-3. [QxMD MEDLINE Link].

Media Gallery

of 0

Table 1. Organic Solvents and Their Common Industrial Uses

Compound	Industrial Uses
Acetone	Cleaning solvent
Acrylamide	Mining and tunneling, adhesives, waste treatment, ore processing
Benzene	Fuel, detergents, paint removers, manufacture of other solvents
Carbon disulfide	Viscose rayon, explosives, paints, preservatives, textiles, rubber cement, varnishes, electroplating
Ethylene oxide (ETO)	Instrument sterilization
N- hexane	Glues and vegetable extraction, components of naphtha, lacquers, metal cleaning compounds
Hydrogen sulfide	Sulfur chemical manufacturing, by-product of petroleum processing, decay of organic matter
Methane	Industrial settings
Methyl mercaptan	Odorant in natural gas and fuels
Methyl-N- butyl ketone	Many industrial uses
Methylene chloride (dichloromethane)	Solvent, refrigerant, propellant
Organochlorine	Insecticides
Organophosphates	Insecticides
PCE	Dry cleaning, degreaser, textile industry
Styrene	Fiberglass component, ship building
Toluene	Paint, fuel oil, cleaning agents, lacquers, paints and paint thinners
1,1,1-Trichloroethane (methyl chloroform)	Degreaser and propellant
TCE	Cleaning agent, paint component, decaffeination, rubber solvents, varnish
Vinyl chloride	Intermediate for polyvinylchloride resins for plastics, floor coverings, upholstery, appliances, packaging
Xylene	Paint, lacquers, varnishes, inks, dyes, adhesives, cements, fixative for pathologic specimens

Table 2. Exposure levels Believed Safe for Workers

Compound	Urine	Blood	Expired Air
Acetone	Acetone, formic acid 100 mg/L	Acetone	Acetone
Benzene	Total phenol 50 mg/g at the end of the shift, trans-trans- muconic acid	Benzene	Benzene before shift, 0.08 ppm; end exhaled, 0.12 ppm
Carbon disulfide	2-TTCA 5 mg/g^*	Carbon disulfide	Carbon disulfide
ETO	None	None	None
N- hexane	2,5-hexanediol 5 mg/g at the end of the shift, 2-hexanol, total metabolites	N- hexane	N- hexane
Hydrogen sulfide	None	None	None
Methane	None	None	None
Methyl mercaptan	None	None	None
Methanol	Formic acid 80 mg/g at the start of the work week, methanol 15 mg/g at the end of the shift	None	Methanol
Methyl-N- butyl ketone	None	2,5-hexane dione	None
Methylene chloride	None	MeCl₂	MeCl₂
Organochlorine	None	None	None
Organophosphates	None	None	None
PCE	PCE, trichloroacetic acid	PCE 1 mg/L	PCE 10 ppm before the last shift of the week
Styrene	End of the shift: mandelic acid (MA) 800 mg, phenylglyoxylic acid (PGA) 240 mg/g) Before shift: MA 300 mg/g or PGA 100 mg/g	Styrene 0.02 mg/L at the start of the shift, 0.55 mg/L at the end of the shift	None
Toluene	Hippuric acid	Toluene	Toluene
1,1,1-Trichlorethane (methyl chloroform)	TCA 10 mg/L at the end of the work week; total trichloroethanol at the end of the shift and at the end of the work week, 30 mg/L	Total trichloroethanol 1 mg/L	Methyl chloroform 40 ppm before the last shift of the work week
TCE	TCE, TCA 100 mg/g at the end of the work week or TCA plus trichloroethanol 300 mg/g	TCE at the end of the work week 4 mg/L	TCE
Vinyl chloride	None	None	None
Xylene	Methylhippuric acid 1.5 g/g at the end of the shift	Xylene	Xylene
^* TTCA - 2-thiothiazolidine 4-carboxylic acid.

Table 3. Recommended Exposure Limits, Organic Solvents

Compound	ppm, mg/m,³
Compound	OSHA PEL as TWAs	NIOSH REL as TWAs, IDLH	ACGIH TLV, STEL
Acetone	1000 (2400)	250 (590), 2500	750 (1780) ceiling, 1000 (2380)
Acrylamide	0.3	(0.03), 60 level for carcinogenicity	None
Benzene	10, 25 ceiling, 50 for 10 min	0.1, STEL 1, 500	10 (32)
Carbon disulfide	20, 30, 100 for 30 min	1 (3), 10 STEL (30), 500	10 (31)
ETO		< 0.1, < 0.18, 5 ceiling, 800	1 (1.8)
N- hexane	500 (1800)	50 (180), 1100	50 (176)
Hydrogen sulfide	20 ceiling, 50 for 10 min once only	10 ceiling, (15) for 10 min, 100	None
Methyl mercaptan	10 ceiling (20)	0.5 ceiling, (1) for 15 min, 150	None
Methanol	200 (260)	200 (260), 250 STEL (325), 6000	262 (200), 328 (250)
Methyl-n- butyl ketone	100 (410)	None	5 (20)
Methylene chloride	25, 15 STEL for 15 min	2300 level for carcinogenicity	50 (174) ceiling
Perchloroethylene	100, 200 ceiling, 300 for 5 min in 3 h	150 level for carcinogenicity	25 (170), 100 (685)
Styrene	100, 200 ceiling, 600 for 5 min in 3 h	50 (215), 100 ST (425), 700	50 (213), 100 (428)
Toluene	200, 300, 500 for 10 min	100 (375), 150 STEL (560), 500	50 (188)
1,1,1-Trichlorethane (methyl chloroform)	350 (1900)	Ceiling 350 (1900) for 15 min, 700	350 (1910), 450 (2460)
Trichloroethylene	100, 200 ceiling, 300 for 5 min in 2 h	1000 level for carcinogenicity	50 (269), 100 (1070)
Vinyl chloride	1, 5 for 15 min	Not determined	None
Xylene	100 (435)	100 (435), 150 STEL (655)	100 (434),150 (651)
Abbreviations—ACGIH = American Congress of Governmental Industrial Hygienists, IDLH = Immediately dangerous to life or health; NIOSH = National Institute for Occupational Safety and Health, OSHA = Occupational Safety and Health Administration, PEL = permissible exposure limit, REL = recommended exposure limit; STEL = short-term exposure limit; TWA = time-weighted average.

Back to List

Author

Jonathan S Rutchik, MD, MPH, FACOEM Associate Clinical Professor, Division of Occupational Medicine, Department of Medicine, University of California, San Francisco, School of Medicine; Neurology, Environmental and Occupational Medicine Associates (www.neoma.com)

Jonathan S Rutchik, MD, MPH, FACOEM is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American College of Occupational and Environmental Medicine, International Parkinson and Movement Disorder Society, Society of Toxicology, Western Occupational and Environmental Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Glenn Lopate, MD Associate Professor, Department of Neurology, Division of Neuromuscular Diseases, Washington University in St Louis School of Medicine; Consulting Staff, Department of Neurology, Barnes-Jewish Hospital

Glenn Lopate, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, Phi Beta Kappa

Disclosure: Nothing to disclose.

Chief Editor

Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS † Professor Emeritus of Neurology and Psychiatry, Clinical Professor of Medicine, Clinical Professor of Family Medicine, Clinical Professor of Neurosurgery, State University of New York Upstate Medical University; Neuroscience Director, Department of Neurology, Crouse Irving Memorial Hospital

Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS is a member of the following medical societies: American Academy of Neurology, American Academy of Pain Medicine, American College of Forensic Examiners Institute, American College of International Physicians, American College of Physicians, American Heart Association, American Stroke Association, National Association of Managed Care Physicians, Royal College of Physicians, Royal College of Physicians and Surgeons of Canada, Royal College of Surgeons of England, Royal Society of Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Roberta J Seidman, MD Associate Professor of Pathology, Director of Neuropathology, Department of Pathology, Renaissance School of Medicine at Stony Brook University, Stony Brook Medicine

Roberta J Seidman, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuropathologists, New York Association of Neuropathologists (The Neuroplex)

Disclosure: Nothing to disclose.

Sections Organic Solvent Neurotoxicity
Overview
Presentation
- History
- Physical
- Causes
- Show All
DDx
Workup
Treatment
Medication
Follow-up
Tables
References

Organic Solvent Neurotoxicity Differential Diagnoses

Diagnostic Considerations

Differential Diagnoses

References

Tables

Contributor Information and Disclosures

What would you like to print?