Substance abuse/toxins

Question 1

What can MPTP (found in some artificial street heroin) cause?

Answer 1

Damage to the substantia nigra leading to a rapid onset of symptoms indistinguishable from Parkinson’s

Question 2

What damage does triorthocresyl phosphate cause to the nervous system?

Answer 2

Causes a severe motor polyneuropathy

Question 3

Very young children may die of brain herniation secondary to what?

Answer 3

Massive brain edema

Question 4

How does lead poisoning often present in adults?

Answer 4

Bilateral neuropathies with the radial nerve being the most common nerve affected (wrist drop). Patients may also get abdominal pain, constipation, anemia, basophilic stippling of erythrocyte precursors, and lead lines of the gums.

Question 5

What medication is used to treat lead poisoning?

Answer 5

Penicillamine

Question 6

What is the clinical picture of ergotism (ergot poisoning)?

Answer 6

Degeneration of the posterior columns and dorsal roots (sensory neuropathy). Patients may also be ataxic with absent deep tendon reflexes. Ulcers may be present due to the vasoconstricting properties of ergot.

Question 7

What neurologic problems are seen with manganese inhalation (miners)?

Answer 7

Parkinsonism, axial rigidity, dystonia. Neuronal loss is seen in the globus pallidus, putamen, caudate, hypothalamus, and cerebellum

Question 8

What CNS damage may be seen following CO poisoning?

Answer 8

There may be delayed neurological degeneration occurring 1-3 weeks following exposure. This usually takes the form of an extrapyramidal disorder with parkinsonian gait and bradykinesia. Imaging shows hypodensities of the globus pallidus.

Question 9

What does ciguatera food poisoning cause?

Answer 9

Poisoning occurs when patients eat fish from the tropics. Ciguatoxin acts on voltage-gated sodium channels leading to increased permeability, which causes paresthesias, headache, fatigue, ataxia, myalgias, abdominal pain/nausea, vomiting, and diarrhea. Many patients complain of temperature reversal (cold objects feel hot). Mannitol appears to have some benefit as treatment.

Question 10

What is lathyrism?

Answer 10

When someone consumes a large amount of chickling pea (L. sativus) in their diet - characterized by subacute onset of spastic paraparesis.

Question 11

What neurologic symptoms does thallium toxicity cause?

Answer 11

A painful, symmetric, primarily sensory neuropathy. Can also cause headache, seizures, nausea/abdominal pain, and hair loss