Presentation
Acute arsenic intoxication presenting as Guillain-Barre-like syndrome. Muscle and Nerve, 10 (2), 114-120. DOI: 10.1002/mus.880100203 Acute arsenic intoxication presenting as Guillain-Barre-like syndrome. / Donofrio, P. D.; Wilbourn, A. [experts.umich.edu]
However, the present work has some limitations. [jstage.jst.go.jp]
In developing its educational products ATSDR has made a diligent effort to ensure the accuracy and the currency of the presented information. [atsdr.cdc.gov]
However, Sjögren syndrome sometimes presents with sensory neuropathy or ganglioneuritis. Ribosomal P antibody may be present in these individuals. [questdiagnostics.com]
Material and methods In the present study, 20 samples of opium were analysed for the presence of arsenic. [unodc.org]
Entire Body System
- Swelling
Hypothyroidism leads to slowing of metabolism, retention of fluid by the body, and swelling of the tissues, which can put pressure on the nerves. [news-medical.net]
Neurological symptoms associated with lead overexposure include an impaired ability to coordinate voluntary movements (ataxia), brain damage (encephalopathy), seizures, convulsions, swelling of the optic nerve (papilledema), and/or impaired consciousness [rarediseases.org]
View/Print Table TABLE 6 Neuropathies with Abrupt/Rapid Onset Ischemic neuropathies Polyarteritis nodosa Rheumatoid arthritis Diabetes mellitus Cranial neuropathies Diabetic amyotrophy Nerve compression Hemorrhage Swelling within a restricted anatomic [aafp.org]
Seizure associated with brain swelling may also occur in lead encephalopathy. [file.scirp.org]
Blood also carries proteins and enzymatic cofactors that will cause tissue inflammation and swelling upon bleeding outside of the vessels into the tissue. [diamondhead.net]
- Burning Feet
[…] and motor weakness (most common presentation) Burning-foot syndrome : ↓ fine touch, vibration :, pain, tingling, pins-and-needles sensation or formication. [amboss.com]
Tricyclic antidepressants such as amitriptyline or anticonvulsants such as gabapentin are useful for relief of neuropathic pain (eg, diabetic burning feet). [merckmanuals.com]
The associated pain or pins-and-needles, burning, crawling, or prickling sensations form a typical "stocking" distribution in the feet and lower legs. [medical-dictionary.thefreedictionary.com]
- Painter
Wrist drop occurred often in painters using lead paint. Painters would lick the tip of their brushes to bring it to a point resulting in chronic exposure (8). Figure 3. A painter with wrist drop (8). Not only wrists are affected from lead exposure. [faculty.virginia.edu]
Inst Occup Health 160:1–48 Google Scholar Husman K, Karli P (1980) Clinical neurological findings among car painters exposed to a mixture of organic solvents. [link.springer.com]
Long term exposure leads in some workers (spray painters or microelectronics workers for example) to the development of “Chronic Solvent induced Encephalopathy”. [file.scirp.org]
- Difficulty Climbing Stairs
Proximal involvement may result in difficulty climbing stairs, getting out of a chair, lifting and swallowing, and in dysarthria. [aafp.org]
Gastrointestinal
- Diarrhea
Overexposure may cause fatigue, headaches, nausea, vomiting, abdominal cramps, diarrhea, and fever. [rarediseases.org]
This is followed by severe abdominal pain, cramping, diarrhea, and vomiting. The diarrhea begins with "rice water" stools progressing to a bloody discharge. Stools and breath may have a garlicky odor. [emedicine.medscape.com]
[…] night Cranial nerve involvement is very common (especially of the oculomotor and abducens nerve ) Trophic skin changes ; (due to autonomic neuropathy ): anhidrosis ;, edema, ulcers Autonomic features: erectile dysfunction, gastric atony ;, postprandial diarrhea [amboss.com]
Symptoms may include problems with blood pressure, voiding, passage of stools ( diarrhea, or constipation ), heart rate, or sweating. Cranial neuropathy is similar to peripheral neuropathy, except that the cranial nerves are involved. [medicinenet.com]
Impairment of the Intestines results in diarrhea or constipation. [diamondhead.net]
- Abdominal Pain
Additional symptoms may include fever, headaches, fatigue, sluggishness (letheragy), vomiting, loss of appetite (anorexia), abdominal pain, constipation, joint pain, loss of recently acquired skills, incoordination, listlessness, difficulty sleeping [rarediseases.org]
This is followed by severe abdominal pain, cramping, diarrhea, and vomiting. The diarrhea begins with "rice water" stools progressing to a bloody discharge. Stools and breath may have a garlicky odor. [emedicine.medscape.com]
Gastrointestinal (GI): Hypersalivation, abdominal pain, vomiting, diarrhoea leading to hypovolaemic shock. Trivalent arsenic is corrosive - may cause oral burns, dysphagia and GI bleeding. Cardiovascular: Myocardial depression. [patient.info]
pain Renal failure Hypertension Gums: Blue discoloration 27. [slideshare.net]
Some patients experience pain from mostly sensory polyneuropathy but it pales in comparison to the motor abnormalities. Symptoms unrelated to neuropathy are abdominal pain, constipation, and anemia. [faculty.virginia.edu]
Skin
- Hyperkeratosis
General examination revealed normal vitals, presence of pallor and hyperkeratosis over the lower limbs. Nervous system examination showed normal higher mental functions and cranial nerves. [annalsofneurosciences.org]
The types of skin lesions occurring most frequently in arsenic-exposed humans are hyperpigmentation, hyperkeratosis, and skin cancer. [lectrochi.com]
S., Persistent neuropathy and hyperkeratosis from distant arsenic exposure. Journal of Agromedicine, 10 (4), 43-54 (2005). Bates, M. N., Smith, A. H. and Hopenhayn-Rich, C., Arsenic ingestion and internal cancers: a review. [consultox.com]
Skin and nail symptoms include hardened patches of skin (hyperkeratosis) with unusually deep creases on the palms of the hands and the soles of the feet, unusual darkening of certain areas of the skin (hyperpigmentation), transverse white bands on the [rarediseases.org]
- Keratosis
[…] arsenic trioxide Sulfur containing substances in garlic may scavenge arsenic from tissue and blood Clinical images Images hosted on other servers : Pigment changes and palmoplantar hyperkeratoses are characteristic of chronic arsenic exposure Arsenic keratosis [pathologyoutlines.com]
Clinical evaluation of arsenical keratosis. Korean J Dermatol 2000; 38 : 1461-7. 15) Oh SJ. Electrophysiological profile in arsenic neuropathy. J Neurol Neurosurg Psychiatry 1991; 54 : 1103-5. [jstage.jst.go.jp]
Musculoskeletal
- Myalgia
Chronic exposure is associated with mucosal irritation, desquamating rash, myalgias, peripheral neuropathy, and white transverse (Mees) lines in the fingernails. (Adams et al., Principles of Neurology, 6th ed, p1212) [xmri.com]
Chronic exposure is associated with mucosal irritation, desquamating rash, myalgias, peripheral neuropathy, and white transverse (Mees) lines in the fingernails. [connects.catalyst.harvard.edu]
- Numbness of the Feet
Malnutrition and alcohol abuse Burning, stabbing pains and numbness in the feet, and sometimes in the hands, are distinguishing features of alcoholic neuropathy. [medical-dictionary.thefreedictionary.com]
Neurologic
- Tremor
Overexposure to tin may damage the nervous system and cause psychomotor disturbances including tremor, convulsions, hallucinations, and psychotic behavior. [rarediseases.org]
Tremor is often related in mercury intoxication, and more obvious tremor, associated with ataxia (lack of coordination of muscular action), may be seen after toluene inhalation. [file.scirp.org]
Inhalation of arsenic compounds may result in upper respiratory irritation, conjunctivitis, peripheral neuropathy (numbness of extremities, muscle weakness, tremors), encephalopathy (hallucinations, emotional lability, memory loss), Raynaud's phenomena [consultox.com]
Peripheral Neuropathy Types Peripheral Neuropathy Symptoms Peripheral Neuropathy Tremors Last Updated: Aug 23, 2018 Written by Dr. Liji Thomas Dr. [news-medical.net]
On occasion, when significant proprioceptive deafferentation occurs, patients are found to have altered joint position sense that can manifest as an ataxia or tremor of the affected limbs and an imbalance of gait and station. [clevelandclinicmeded.com]
- Dysesthesia
The common symptoms are as follows: numbness and/or tingling of extremities; burning or electric pain; dysesthesia; trouble with balance; dizziness; vision changes; and so on. [synapse.koreamed.org]
Small-fiber neuropathies often present with burning pain, lightning-like or lancinating pain, aching, or uncomfortable paresthesias (dysesthesias). [aafp.org]
Loss of function “- symptoms” Disordered function “+ symptoms” Sensory “Large Fiber” ↓ Vibration ↓ Proprioception Hyporeflexia Sensory ataxia Paresthesias Sensory “Small Fiber” ↓ Pain ↓ Temperature Dysesthesias Allodynia The clinical response to sensory [slideshare.net]
Sensory effects, particularly painful dysesthesia, occur earlier and may predominate in moderate poisoning, whereas ascending weakness and paralysis may predominate in more severe poisoning. [lectrochi.com]
In addition to sensory loss, patients often complain of paresthesias and dysesthesias, often characterized by a sense of numbness, tingling, prickling, and pins-and-needles sensations. [clevelandclinicmeded.com]
- Headache
Overexposure may cause headaches, drowsiness, confusion, seizures, and life-threatening complications. [rarediseases.org]
The resulting neurotoxic effects may include nausea, dizziness, headache, and problems in concentration. [file.scirp.org]
In acute exposure to the gaseous form, inhalation of toxic amounts of arsine gas results in headache, malaise, weakness, dizziness, and dyspnea accompanied by gastrointestinal distress. [emedicine.medscape.com]
Associated disorders Pain: Abdominal; Headache; Joint General: Fatigue; Irritability Anemia Sickle cell disease Electrophysiology Motor Axon loss Mild cases: Prolonged distal latencies or Normal Sensory Vibratory thresholds: Increased [slideshare.net]
- Confusion
Overexposure may cause headaches, drowsiness, confusion, seizures, and life-threatening complications. [rarediseases.org]
The immune system launches an attack against the bacteria; but, according to the theory, the immune system confuses the myelin with the bacteria in some cases and attacks the myelin sheath as well. [medical-dictionary.thefreedictionary.com]
- Flaccid Paralysis
[…] hereditary peripheral nerve disorders due to impaired Schwann cell growth and function Etiology Usually autosomal dominant Associated with scoliosis and f oot deformities ; (flat feet, high arches ;, hammer toes ) Characteristic feature : Ascending flaccid [amboss.com]
paralysis Laboratory studies If a toxin is suspected, heavy metal screening should be performed. [now.aapmr.org]
Treatment
What is the treatment for peripheral neuropathy and its symptoms? Can peripheral neuropathy be cured? The treatment for peripheral neuropathy depends on its cause. The first step in treatment is, therefore, to look for the cause. [medicinenet.com]
For the treatment of DN, tight glucose control should be preceded [ 5 ]. [synapse.koreamed.org]
Despite treatment with succimer meso-2,3-dimercaptosuccinic acid, her neuropathy progressed to ventilator dependence and quadriplegia. [ncbi.nlm.nih.gov]
Fortunately, treatment can be very helpful in the management of neuropathy symptoms. But before any treatment can begin, the most important step is to determine the underlying cause of the neuropathy to plan the correct course of treatment. [mollysfund.org]
Treatment Definitive therapy : treat the underlying disease! [amboss.com]
Prognosis
Prognosis varies depending on the severity of nerve damage done by the medication. Conclusions As described in this review, there are many different kinds of polyneuropathies although their symptoms and signs might look similar. [synapse.koreamed.org]
Pregnancy and breast-feeding: arsenic is probably transferred to the baby via the placenta and breast milk. [ 2 ] Prognosis [ 2 ] The prognosis varies with the amount and rate of arsenic ingestion. [patient.info]
Lancet I: 791–794 Google Scholar Juntunen J, Antti-Poika M, Tola S, et al. (1982) Clinical prognosis of patients with diagnosed chronic solvent intoxication. [link.springer.com]
Prognosis Each patient's prognosis depends on the severity of the neuropathy when exposure is ceased or reduced to levels that will not affect health negatively. 44. [slideshare.net]
Etiology
Code First Code First Help Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10data.com]
Diagnostic tests, usually beginning electrodiagnostic testing, are indicated in patients with atypical clinical features, unknown etiology, and/or severe or rapidly progressive symptoms. [amboss.com]
Though the etiological agent could not be confirmed with investigations, probable toxin induced polyneuropathy due to arsenic still remains the most likely diagnosis. [annalsofneurosciences.org]
We conducted an open label study of patients with peripheral neuropathy of multiple etiologies. [practicalpainmanagement.com]
[…] various forms of polyneuropathy are categorized by the type of nerve affected (e.g., sensory, motor, or autonomic), by the distribution of nerve injury (e.g., distal vs. proximal), by nerve component primarily affected (e.g., demyelinating vs. axonal), by etiology [fpnotebook.com]
Epidemiology
Epidemiologic Reviews, 16 (2), 184-209 (1994). Enterline, P. E. and Marsh, G. M., Cancers among workers exposed to arsenic and other substances in a copper smelter. American Journal of Epidemiology, 116 (6), 895-911 (1982). Falk, H., Caldwell, G. [consultox.com]
Epidemiological evidence indicates that chronic arsenic exposure is associated with vasospasm and peripheral vascular insufficiency. [lectrochi.com]
[…] table Free element of arsenic appears in two allotropic forms: grey and yellow (crystalline) Can also exist in various oxidation states, inorganic and organic forms, exposure to inorganic arsenic is associated with most cases of arsenic induced toxicity Epidemiology [pathologyoutlines.com]
Lead Epidemiology of lead toxicity Common in children: Especially black non-hispanic children (22%) Most common in homes built from 1920 to 1950 Identical twins often have concordant lead levels Lead neuropathy: Especially from industrial exposure [slideshare.net]
Causation and causal inference in epidemiology. Am J Public Health 95 (Suppl 1): S144–50, 2005. Dalakas MC. Peripheral neuropathy and antiretroviral drugs. J Periph N Syst 6:14-20, 2001. Gaist D, Jeppesen U, Anderson M, et al. [now.aapmr.org]
Pathophysiology
[…] is present in air, usually due to volcanic eruption and purposeful human activities Arsenic also found as sulphuric compound in lead, copper, nickel and ferrous ores; also in soil in small quantities Also a medicinal used by physicians for 2000 years Pathophysiology [pathologyoutlines.com]
Our grasp of the pathophysiologic basis of the clinical PN has increased rapidly, but these advances are primarily descriptive and little progress has been made in understanding the fundamental pathogenic events that underlie the polyneuropathies. [practicalpainmanagement.com]
Because pathophysiology and symptoms are related, polyneuropathies are often classified by area of dysfunction: Myelin Vasa nervorum Axon Polyneuropathies may be acquired or inherited. [merckmanuals.com]
Pathophysiology Although peripheral neuropathy has multiple etiologies, the nerve has a limited number of ways to respond to injury. 4, 5 The damage can occur at the level of the axon (i.e., axonopathy). [aafp.org]
Back to Top Pathophysiology and Natural History Despite the diverse array of medical disorders that cause peripheral neuropathies, peripheral nerves exhibit only a few distinct pathologic reactions to an insult or disease: wallerian degeneration, axonal [clevelandclinicmeded.com]
Prevention
Rapidly find the answers you need with separate sections on diseases and disorders, differential diagnosis, clinical algorithms, laboratory results, and clinical preventive services, plus an at-a-glance format that uses cross-references, outlines, bullets [books.google.com]
SLIDESHOW Diabetic Peripheral Neuropathy: Improve Diabetes Nerve Pain See Slideshow Can peripheral neuropathy be prevented? Certain forms of peripheral neuropathy can be prevented. [medicinenet.com]
Knowledge of the pathogenesis, genetics, and molecular biology of neuromuscular disorders is essential both in developing and applying new therapies and preventive measures, and in formulating genetic and prognostic advice. [books.google.de]
Phenytoin, which is prescribed to prevent seizures, and disulfiram, which is given to fight alcohol addition, both have been linked to peripheral neuropathy. [livestrong.com]