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Lead Encephalopathy

Toxic Encephalitis Due to Lead


Presentation

  • We review a case of lead poisoning in a 9-month-old child who presented clinically and radiographically with a posterior fossa mass effect and obstructive hydrocephalus.[ncbi.nlm.nih.gov]
  • We present her hospital course and review the management of lead encephalopathy in detail.[ncbi.nlm.nih.gov]
  • As an illustration, we describe a patient with chronic cumulative lead intoxication, who presented with peripheral neuropathy, anaemia, and a 'lead line' on the gingiva.[ncbi.nlm.nih.gov]
  • Abstract We studied 19 infants with a mean age of 3.8 months who presented with features consistent with acute lead encephalopathy following the use of traditional medicines.[ncbi.nlm.nih.gov]
  • Lead encephalopathy is a severe manifestation of lead poisoning that can present with altered mental status and seizures and has been associated with illicit moonshine consumption.[ncbi.nlm.nih.gov]
Fever
  • There was no history of fever or symptoms suggestive of raised intracranial pressure, seizures, or focal motor or sensory deficits. The patient denied consumption of alcohol on a regular basis.[jnnp.bmj.com]
  • The plaintiff contended that the lead had set off a febrile, or fever-related, seizure. The plaintiff's lawyers used Dr. Peter Kaplan, of Johns Hopkins Bayview, as their expert witness on this theory of the case.[bartlit-beck.com]
  • The boy has not had a fever, cough, runny nose, or diarrhea, and he has been producing a normal amount of urine. The patient has not traveled anywhere recently; however, he did receive several new toys from a relative in China about 2 months ago.[medbullets.com]
  • Serious reactions to CaNa 2 EDTA include renal insufficiency, proteinuria, microscopic hematuria, fever, and diarrhea. Renal toxicity, which is dose-related, is usually reversible. Adverse effects of CaNa 2 EDTA are probably due to zinc depletion.[msdmanuals.com]
  • AEs include local injection site reactions, fever, hypercalcemia, renal insufficiency, and excretion of other essential minerals. 36-38 Succimer is an oral water-soluble dimercaprol analogue associated with fewer AEs than parenteral chelators.[pharmacytimes.com]
Vomiting
  • We report the case of a 7-month-old child who presented with regression of milestones, seizures, altered sensorium, and vomiting. An elder sibling had died of similar complaints.[ncbi.nlm.nih.gov]
  • , lack of sensory perception, diminished libido, syncope, tremor, irritability, seizure, ataxia, restlessness, and behavioral abnormalities. 1, 2, 6, 7, 9 In severe conditions, cerebral or cerebellar edema may develop; such patients may present with vomiting[ajnr.org]
  • A 68-year-old woman was admitted to our hospital in October 2003, with a 1-month history of fatigue, vomiting, and abdominal pain. Clinical examination revealed hypertension as a new finding but was otherwise normal.[neurology.org]
  • Dimercaprol, which can cause vomiting, is given with parenteral or oral fluids.[msdmanuals.com]
  • Adverse effects (AEs) include nausea and vomiting (N/V), headache, tachycardia, and leukopenia.[pharmacytimes.com]
Nausea
  • […] lead-containing material (e.g. contaminated water, paints, batteries). neuropsychiatric amnesia: short term memory poor concentration ataxia dysarthria sensory loss and paraesthesia in the extremities fatigue, sleep problems headaches depression stupor GI nausea[radiopaedia.org]
  • The vast majority of individuals presented with gastrointestinal symptoms including abdominal pain, nausea, vomiting, anorexia and constipation and of them were found to have elevated BLLs.[jhoonline.biomedcentral.com]
  • An initial euphoria was experienced which may be accompanied by hallucinations, delusions, nausea and vomiting and after prolonged inhalation there may be delirium, loss of consciousness and coma and sudden death may occur.[lead.org.au]
  • Definition of lead poisoning : chronic intoxication that is produced by the absorption of lead into the system and is characterized especially by fatigue, abdominal pain, nausea, diarrhea, loss of appetite, anemia, a dark line along the gums, and muscular[merriam-webster.com]
  • […] extremities Fatigue Irritability Mood disorder Impaired concentration Decline in mental function Loss of hearing Headache Seizures Encephalopathy Loss of memory Muscle pain Muscle coordination problems Gastrointestinal effects Constipation Indigestion Nausea[news-medical.net]
Hypertension
  • Called also AIDS encephalopathy. hypernatremic encephalopathy a severe hemorrhagic encephalopathy induced by the hyperosmolarity accompanying hypernatremia and dehydration. hypertensive encephalopathy a complex of cerebral phenomena such as headache,[medical-dictionary.thefreedictionary.com]
  • The patient had hypertension and had been consuming ayurvedic medicines (Mahayogaraj-gugul) 5 for the past 6 months.[ajnr.org]
  • Caution is needed in children with renal impairment, hypertension, or G6PD deficiency. Adverse effects (AEs) include nausea and vomiting (N/V), headache, tachycardia, and leukopenia.[pharmacytimes.com]
  • Clinical examination revealed hypertension as a new finding but was otherwise normal. Blood test showed a macrocytic anemia and basophilic stippling of erythrocytes on blood smear. Vitamin B 12 level was 141 nmol/L (normal range [NR] 179 to 660).[neurology.org]
  • Hypertensive encephalopathy Hypertensive encephalopathy occurs when blood pressure rises to levels high enough to affect brain function.[emedicinehealth.com]
Aggressive Behavior
  • Signs of repeated lead exposure include: abdominal pain abdominal cramps aggressive behavior constipation sleep problems headaches irritability loss of developmental skills in children loss of appetite fatigue high blood pressure numbness or tingling[healthline.com]
  • Chronic lead poisoning in children may cause intellectual disability, seizure disorders, aggressive behavior disorders, developmental regression, chronic abdominal pain, and anemia.[merckmanuals.com]
Seizure
  • A patient with generalised epileptic seizures, mental and psychotic signs was diagnosed as suffering from lead encephalopathy.[ncbi.nlm.nih.gov]
  • We report the case of a 7-month-old child who presented with regression of milestones, seizures, altered sensorium, and vomiting. An elder sibling had died of similar complaints.[ncbi.nlm.nih.gov]
  • Lead encephalopathy is a severe manifestation of lead poisoning that can present with altered mental status and seizures and has been associated with illicit moonshine consumption.[ncbi.nlm.nih.gov]
  • BACKGROUND: In chronic petrol sniffers, recent exposure to high levels of leaded petrol may give rise to a lead encephalopathy characterised by tremor, chorea, ataxia, hyperreflexia, convulsive seizures, and death.[ncbi.nlm.nih.gov]
  • It can present with multiple seizures, delirium, blindness, aphasia and dementia. Usually it is due to environmental exposure.[cambridge.org]
Headache
  • A 15 year old boy was evaluated in the psychiatric emergency room for the acute onset of "confusion,"insomnia, headache, and shaking of one week's duration.[ncbi.nlm.nih.gov]
  • A 66-year-old woman presented to a hospital with headache, irritability, and altered mental status. On hospital day 16, she was found to have a whole blood lead concentration of 148.2 μg/dL and a 24-h urine lead concentration of 232 μg/day.[ncbi.nlm.nih.gov]
  • , vomiting, ataxia, convulsions, paralysis, stupor, and coma in acute forms, 2, 7, 9, 10 whereas in chronic encephalopathy as in our case, patients present with loss of memory and concentration, depression, disorientation, headache, drowsiness, dizziness[ajnr.org]
  • Called also AIDS encephalopathy. hypernatremic encephalopathy a severe hemorrhagic encephalopathy induced by the hyperosmolarity accompanying hypernatremia and dehydration. hypertensive encephalopathy a complex of cerebral phenomena such as headache,[medical-dictionary.thefreedictionary.com]
  • Very high levels of lead in the blood may cause personality changes, headaches, loss of sensation, weakness, a metallic taste in the mouth, uncoordinated walking, digestive problems, and anemia. The diagnosis is based on symptoms and a blood test.[merckmanuals.com]
Ataxia
  • Two days later hallucinations, formication and a movement disorder emerged characterized by action tremor, myoclonus, chorea and ataxia. Further history revealed inhalation of gasoline for its euphoric effects.[ncbi.nlm.nih.gov]
  • BACKGROUND: In chronic petrol sniffers, recent exposure to high levels of leaded petrol may give rise to a lead encephalopathy characterised by tremor, chorea, ataxia, hyperreflexia, convulsive seizures, and death.[ncbi.nlm.nih.gov]
  • None of the patients had ataxia.[jnnp.bmj.com]
  • The increased resistance of the adult to encephalopathy and ataxia is believed to be caused by the capacity of the mature brain to sequestrate lead away from its mitochondrial site of action within the cerebral and cerebellar neurons. 4 Case Report A[ajnr.org]
  • Wernicke's encephalopathy a neurological disorder characterized by confusion, apathy, drowsiness, ataxia of gait, nystagmus, and ophthalmoplegia; it is due to thiamine deficiency, usually from chronic alcohol abuse.[medical-dictionary.thefreedictionary.com]
Confusion
  • A 15 year old boy was evaluated in the psychiatric emergency room for the acute onset of "confusion,"insomnia, headache, and shaking of one week's duration.[ncbi.nlm.nih.gov]
  • Wernicke's encephalopathy a neurological disorder characterized by confusion, apathy, drowsiness, ataxia of gait, nystagmus, and ophthalmoplegia; it is due to thiamine deficiency, usually from chronic alcohol abuse.[medical-dictionary.thefreedictionary.com]
  • There may be memory loss and confusion, loss of coordination and ataxia with a wobbling gait (walk), and confusion. Non-alcohol related causes can include AIDS , cancer , renal (kidney) dialysis, and hyperthyroidism (thyrotoxicosis).[emedicinehealth.com]
  • If patients with hypoglycemia are given glucose at the first signs of encephalopathy (for example, irritability, mild confusion), most patients recover completely.[medicinenet.com]
  • […] age, and treatment Presentation Symptoms, typically nonspecific, result from lead toxicity abdominal colic (lead colic) nausea vomiting anorexia pain toxicity to renal tubues interstitial nephritis reversible with therapy CNS abnormalities memory loss confusion[medbullets.com]
Tremor
  • Two days later hallucinations, formication and a movement disorder emerged characterized by action tremor, myoclonus, chorea and ataxia. Further history revealed inhalation of gasoline for its euphoric effects.[ncbi.nlm.nih.gov]
  • BACKGROUND: In chronic petrol sniffers, recent exposure to high levels of leaded petrol may give rise to a lead encephalopathy characterised by tremor, chorea, ataxia, hyperreflexia, convulsive seizures, and death.[ncbi.nlm.nih.gov]
  • […] progressing to global dementia. hepatic encephalopathy a condition, usually occurring secondary to advanced liver disease, marked by disturbances of consciousness that may progress to deep coma (hepatic coma), psychiatric changes of varying degree, flapping tremor[medical-dictionary.thefreedictionary.com]
  • There was no tremor and no sensory deficits. Deep tendon reflexes were normal. Both plantar reflexes were extensor. There was no neck stiffness.[jnnp.bmj.com]
  • […] in acute forms, 2, 7, 9, 10 whereas in chronic encephalopathy as in our case, patients present with loss of memory and concentration, depression, disorientation, headache, drowsiness, dizziness, lack of sensory perception, diminished libido, syncope, tremor[ajnr.org]

Workup

  • Further workup revealed severe iron deficiency anemia, and treatment with ferrous sulfate was started after completion of chelation therapy. The family moved out of the home.[consultant360.com]
Brain Edema
  • Lead poisoning affects multiple organs: specifically bones (lead bands at the epiphyses of the long bones), blood (punctate basophilic stippling of erythrocytes and microcytic hypochromic hemolytic anemia), brain (brain edema and demyelination of the[ajnr.org]
Neurofibrillary Tangle
  • Numerous pyramidal cells of the forebrain grisea contained Alzheimer's neurofibrillary tangles. The remaining pyramidal cells of the hippocampi exhibited granulo-vacuolar degeneration.[ncbi.nlm.nih.gov]

Treatment

  • The relevant literature concerning the treatment of lead encephalopathy was reviewed during the treatment of this child and preparation of the manuscript.[ncbi.nlm.nih.gov]
  • The hydrocephalus is transient as vermis oedema subsides with medical treatment. Two such cases are reported and discussed.[ncbi.nlm.nih.gov]
  • We report such a case diagnosed by MR imaging in which early treatment for edema avoided neurosurgical exploration. Only six cases have been published since Biemond and Van Creveld's first report in 1939.[ncbi.nlm.nih.gov]
  • Two patients died before starting treatment. Of the 18 patients treated with B.A.L. (2.3 dimercaptopropanol) and EDTA (ethylenediaminetetra-acetic acid), three died.[ncbi.nlm.nih.gov]
  • The specific treatment is chelation therapy, for which a protocol has been developed at the Health Sciences Centre, Winnipeg. Lead encephalopathy, however, is a manifestation of social, cultural and psychologic malaise.[ncbi.nlm.nih.gov]

Prognosis

  • Consequently, the prognosis varies from patient to patient and ranges from complete recovery to a poor prognosis that often leads to permanent brain damage or death.[medicinenet.com]
  • While primary prevention strategies had so far had limited success, the poor prognosis of those severely affected, even with treatment, further emphasised the need for locally based strategies for prevention.[lead.org.au]
  • […] erythrocyte fragility Plain radiograph may show bands of increased density at the metaphyses can affect any metaphysis, but the involvement of the proximal fibula and distal ulnar metaphyses is highly suggestive may show bone-in-bone appearance Treatment and prognosis[radiopaedia.org]
  • […] causing chronic lead poisoning Epidemiology major risk factor is old homes ( painted or made before 1974 ) with chipped paint occupational exposures workers at battery recycling plants patients with pica may be at increased risk inner city children Prognosis[medbullets.com]
  • Encephalopathy Prognosis Research continues to assist in understanding brain function and understanding the mechanisms that can cause encephalopathies.[emedicinehealth.com]

Etiology

Epidemiology

  • Over the past generation, epidemiologic studies have provided the foundation for efforts to combat children’s exposure to lead through primary prevention, early identification via detailed environmental history and blood lead screening, and various treatment[pedsinreview.aappublications.org]
  • Adult blood lead epidemiology and surveillance--United States, 1998-2001. MMWR Surveill Summ. 2002;51:1-10. Center for Disease Prevention and Control. Adult blood lead epidemiology and surveillance--United States 2002. MMWR. 2004;53:578.[pharmacytimes.com]
  • […] to basophilic stippling lead causes toxicity primarily through the generation of reactive oxygen species half-life of 30 days in the blood, giving it time to diffuse into organs half-life of several decades in the bone, causing chronic lead poisoning Epidemiology[medbullets.com]
  • (iv) There may be diffuse astrocytic proliferation in both the gray and white matter (v) Vascular lesions in the brain are particularly prominent with dilatation and proliferation of capillaries. 2) Kidney: Epidemiological studies have demonstrated a[pathopedia-india.com]
  • Adult Blood Lead Epidemiology and Surveillance --- United States, 2002. CDC MMWR [On-line information]. Available online at . Harold E. Hoffman, MD, FRCPC, FACOEM. Occupational & Environmental Medicine. Edmonton, Alberta, Canada. Thomas P.[labtestsonline.it]
Sex distribution
Age distribution

Pathophysiology

  • Lead Poisoning, Diagnosis and Treatment Lead Poisoning Pathophysiology Prevention of Lead Poisoning[news-medical.net]
  • […] screened) had first-ever VBLLs of 10–44.9 µg/dL and thus did not require chelation (and are not reported in this analysis), such that the range of exposure of this cohort of children is consistent with the entire clinical and sub-clinical spectrum of lead pathophysiology[journals.plos.org]

Prevention

  • The administration of lead containing medications to young infants in Oman is a significant preventable cause of morbidity and mortality having implications, in particular, for physicians involved in the care of Arabic communities.[ncbi.nlm.nih.gov]
  • Will require a shift in emphasis to primary prevention. Will take time and resources. Should proceed in a rational manner, with the highest risk children being made the highest priority. Can be achieved.[books.google.de]
  • […] recently published by the Michigan Department of Health and Human Services (MDHHS) and it showed that a good number of children had at least 5 micrograms of lead per deciliter, a volume that is considered critical by the Centers for Disease Control and Prevention[kamagra4uk.net]
  • CDC Childhood Lead Poisoning Prevention Program, CDC Recommendations for Lead Poisoning Prevention in Newly Arrived Refugee Children.[labtestsonline.it]
  • Binns HJ, Campbell C, Brown MJ; Centers for Disease Control and Prevention Advisory Committee on Childhood Lead Poisoning Prevention.[consultant360.com]

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