Abstract
Multiple cranial and peripheral neuropathies as a delayed sequellae of ethylene glycol poisoning is a less well known clinical entity and its information about long-term electrophysiological and clinical outcomes is limited. We report a 45-year-old male who presented with acute renal failure and subsequently developed multiple cranial neuropathy, respiratory failure, and flaccid tetraparesis. Through sequential electrophysiological studies, we would like suggest that the main pathophysiology of ethylene glycol-related neuropathy is a demyelinating polyradiculoneuropathy with secondary axonal degeneration.
REFERENCES
1.Pellegrino B., Parravani A., Cook L., Mackay K. Ethylene glycol intoxication: Disparate findings of immediate versus delayed presentation. W V Med J. 2006. 102:32–34.
2.Zhou L., Zabad R., Lewis RA. Ethylene glycol intoxication: electrophysiological studies suggest a polyradiculopathy. Neurology. 2002. 59:1809–1810.
3.Lewis LD., Smith BW., Mamourian AC. Delayed sequelae after acute overdoses or poisonings: cranial neuropathy related to ethylene glycol ingestion. Clin Pharmacol Ther. 1997. 61:692–699.
4.Hasbani MJ., Sansing LH., Perrone J., Asbury AK., Bird SJ. Encephalopathy and peripheral neuropathy following diethylene glycol ingestion. Neurology. 2005. 64:1273–1275.
5.Alzouebi M., Sarrigiannis PG., Hadjivassiliou M. Acute polyradiculoneuropathy with renal failure: mind the anion gap. J Neurol Neurosurg Psychiatry. 2008. 79:842–844.
6.Tobe TJ., Braam GB., Meulenbelt J., van Dijk GW. Ethylene glycol poisoning mimicking Snow White. Lancet. 2002. 359:444–445.
7.Baldwin F., Sran H. Delayed ethylene glycol poisoning presenting with abdominal pain and multiple cranial and peripheral neuropathies: a case report. J Med Case Reports. 2010. 4:220.
8.Barceloux DG., Krenzelok EP., Olson K., Watson W. American academy of clinical toxicology practice guidelines on the treatment of ethylene glycol poisoning. Ad Hoc Committee. J Toxicol Clin Toxicol. 1999. 37:537–560.
9.Froberg K., Dorion RP., McMartin KE. The role of calcium oxalate crystal deposition in cerebral vessels during ethylene glycol poisoning. Clin Toxicol (Phila). 2006. 44:315–318.
10.Le Quesne PM. Electrophysiological investigation of toxic neuropathies. Acta Neurol Scand Suppl. 1982. 92:75–87.
Table 1.
Examination date (days after admission) | 18 days | 52 days | 91 days | 119 days | |
---|---|---|---|---|---|
Motor (Right) | |||||
Median | Amplitude (Wrist/Elbow), mV | 15.4/14.6 | 14.6/14.2 | 10.5/9.3 | 10.1/9.8 |
Distal latency, msec | 4.29 | 3.75 | 4.08 | 4.08 | |
Velocity (Wrist-Elbow), m/sec | 53.4 | 59.4 | 55.3 | 51.7 | |
F-latency, msec | 33.15 | - | 31.75 | 30.85 | |
Ulnar | Amplitude (Wrist/Elbow), mV | 19.4/18.2 | 18.2/15.2 | 14.9/13.5 | 14.4/13.0 |
Distal latency, msec | 4.77 | 2.64 | 2.7 | 2.67 | |
Velocity (Wrist-Elbow), m/sec | 43.0 | 57.6 | 49.4 | 47.1 | |
F-latency, msec | 36.2 | - | 32.6 | 32.6 | |
Peroneal | Amplitude (Ankle/Fibular head), mV | 2.27/1.71 | 4.77/3.33 | 1.47/0.36* | 0.2/0.052* |
Distal latency, msec | 4.77 | 4.35 | 5.3 | 6.05 | |
Velocity (Ankle-Fibular head), m/sec | 40.5 | 41.6 | 30.8 | 33.8 | |
F-latency, msec | - | - | - | - | |
Tibial | Amplitude (Ankle/Popliteal fossa), mV | 16.66/11.62 | 15.28/13.22 | 6.27/2.58* | 3.05/1.43* |
Distal latency, msec | 4.29 | 4.71 | 6.15 | 6.09 | |
Velocity (Ankle-Popliteal fossa), m/sec | 40.0 | 40.4 | 29.4 | 33.4 | |
F-latency, msec | 53.2 | - | - | - | |
H-latency (Right/Left) | -/- | -/- | -/- | -/- | |
Sensory (Right) | |||||
Median | Amplitude (Wrist/Elbow), μV | 21.8/20.7 | 18.9/25.8 | 28.0/23.8 | 22.6/26.6 |
Velocity (Finger-Wrist/Wrist-Elbow), m/sec | 40.1/50.0 | 50.7/58.9 | 43.4/49.2 | 43.0/51.5 | |
Ulnar | Amplitude (Wrist/Elbow), μV | 13.1/14.9 | 16.1/22.7 | 10.4/16.2 | 10.8/16.9 |
Velocity (Finger-Wrist/Wrist-Elbow), m/sec | 35.9/49.8 | 47.9/56.5 | 45.9/48.2 | 45.3/46.7 | |
Sural | Amplitude, μV | 8.0 | 13.30 | 6.10 | - |
Velocity, m/sec | 35.1 | 38.0 | 28.2 | - |