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Toxic Injuries

A 42-year-old man has had 6 to 15 drinks per day for the past 15 years. He is healthy overall, but has difficulty with tandem gait. Which of the following is the most common site of central nervous system (CNS) atrophy associated with chronic alcoholism?

a. The superior vermis

b. Wernicke area

c. The supraorbital gyrus

d. The angular gyrus

e. The flocculus

The answer is a. The superior vermis of the cerebellum loses Purkinje cells and exhibits atrophy of the molecular layer in alcoholic persons after years or decades of ethanol use. Alcoholic patients may have gait instability and limb ataxia associated with this injury, but the clinical signs are usually fairly mild considering the histologic damage done by ethanol. White matter in the cerebellum is relatively unaffected.

An 83-year-old man gives a history of being poisoned by “jake” when drinking illicit alcohol as a young man. After doing some research you learn that “jake” is actually triorthocresyl phosphate. Triorthocresyl phosphate is an organophosphate that may cause lethal neurological complications by which of the following means?

a. Eliciting massive intracerebral edema

b. Causing a severe motor polyneuropathy

c. Producing widespread CNS demyelination

d. Allowing CNS infections secondary to generalized immunosuppression

e. Inducing status epilepticus

The answer is b. Triorthocresyl phosphate damages both upper and lower motor neurons. This damage is usually severe and likely to be permanent. Death may occur within a few days of severe exposure. This material is a common constituent of rat poisons, roach powders, and other insecticides. Oral ingestion is usually required for substantial toxicity. The acute symptoms of poisoning reflect the anticholinesterase activity of the poison. This produces headaches, vomiting, abdominal cramps, excessive sweating, wheezing, and twitching.

A 1-year-old child is brought to the emergency room with an acute encephalopathy. It is determined that the etiology is lead intoxication. With severe lead poisoning, very young children may die of brain herniation secondary to which of the following?

a. Subdural hematomas

b. Epidural hematomas

c. Intracerebral hemorrhage

d. Obstructive hydrocephalus

e. Massive brain edema

The answer is e. Lead poisoning may cause ataxia and tremor in children exposed ...

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