Summary
In West Berlin in the autumn of 1975 through the following 5 months we observed 18 juvenile patients who had a toxic polyneuropathy and had sniffed a glue thinner. The neurological picture consisted of a symmetrical, progressive, ascending, mainly motor, polyneuropathy with pronounced muscle atrophy and characteristic vegetative alterations. The height of the disease was reached after 11/2–21/2 months and was characterized by tetraplegia in 7 patients. After 8 months all patients still had a motor deficit. Nerve biopsy showed paranodal axon swelling, dense masses of neurofilaments and secondary myelin retraction. The neurological and morphological data correspond to the “glue sniffer's neuropathy” and the n-hexane and MBK polyneuropathy after industrial exposure, as described in 10 cases to date. However, there was no MBK in the glue thinner. The polyneuropathies occurred in close time relation with the denaturation of the thinner with MEK (2-butanone). It is concluded from the data n-hexane and MBK have a common toxic mechanism with primary axonal changes and that there is an additional synergistic effect of MEK.
Zusammenfassung
Ab Herbst 1975 traten in West-Berlin innerhalb von fünf Monaten 18 Fälle toxischer Polyneuropathien bei Jugendlichen auf, die einen Klebstoffverdünner geschnüffelt hatten. Das neurologische Syndrom bestand in einer symmetrischen, progressiven, von distal aszendierenden, vorwiegend motorischen Polyneuropathie mit ausgeprägten Muskelatrophien und charakteristischen vegetativen Veränderungen. Der Höhepunkt der Erkrankung war nach 11/2 bis 21/2 Monaten erreicht und führte in 7 Fällen zu Tetraplegien; nach 8 Monaten waren noch bei allen Erkrankten motorische Aufälle vorhanden. Nervenbiopsien zeigten paranodal Axonanschwellungen, Verklumpung der Neurofilamente und sekundäre Myelinretraktionen. Neurologische und morphologische Daten entsprachen der bisher in 10 Fällen beschriebenen “glue sniffer's neuropathy” sowie den n-Hexan- und Methyl-Butyl-Keton (MBK)-Polyneuropathien nach industrieller Exposition. MBK war jedoch im Verdünner nicht enthalten. Die Polyneuropathien traten in direktem zeitlichen Zusammenhang mit der Vergällung des Verdünners mit Methyl-Ethyl-Keton (MEK) auf. Aus den Daten wird auf einen n-Hexan und MBK gemeinsamen Schädigungsmechanismus mit primär axonalem Angriffspunkt sowie einen zusätzlichen synergistischen Effekt des MEK geschlossen.
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Altenkirch, H., Mager, J., Stoltenburg, G. et al. Toxic polyneuropathies after sniffing a glue thinner. J Neurol 214, 137–152 (1977). https://doi.org/10.1007/BF02430351
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DOI: https://doi.org/10.1007/BF02430351