Ataxia with Parkinsonism and dystonia after intentional inhalation of liquefied petroleum gas

Abstract

The practice of inhaling liquefied petroleum gas (LPG) to commit suicide is uncommon and almost exclusively a prerogative of the prison population. Numerous cases of sudden deaths caused by intentional propane and/or butane inhalation have been described, but these cases survived and a description of the consequences is very rare. We describe a prisoner who survived after voluntary inhalation of LPG, and who developed ataxia, Parkinsonism, and dystonia. Brain MRI showed bilateral hyperintensity in the basal ganglia and in the cerebellar hemispheres. The clinical evolution and the MRI abnormalities are similar to those described in cases of poisoning by CO where the mechanism of brain injury is related to histotoxic hypoxia. We believe that LPG, considered until now a mixture of gas with low neurotoxic power, may have caused direct toxic damage to the brain, mediated by a mechanism of hypoxia, such as in CO intoxication.

A two‐decade review of butane toxicity as a substance of abuse

“…Two patients inhaled liquefied petroleum gas, a propane/butane gas mixture. To facilitate reading, data are summarized in Table 1 for survivors 8,13–22 and Table 2 for fatalities 1–4,14,15,18,20,23–43 . Patients were predominantly males (81%) aged between 11 and 70 years (mean age ± SD, 23 ± 13 years).…”

A Case Report: Convulsion and Reduced Level of Consciousness in Two Children Following Liquefied Petroleum Gas Inhalation

“…These hydrocarbons are lipophilic and it seems that after inhalation into the lungs and being absorbed into the blood, they enter fat-rich tissues (especially brain and fat tissues) and cause neurological symptoms including reduced level of consciousness, convulsion, ataxia, etc. [5].…”

The role of ethanethiol in deaths from acute poisoning by gas mixtures: A suicide case involving a decomposed corpse and a review of the literature

“…The inhalation of volatile substances is a rare method of suicide, despite being a common method of substance abuse worldwide (volatile substance abuse). Adult prisoners are the most likely group to use volatile substances to commit suicide, 1,2 while adolescents are most likely to use them as an intoxicant due to their easy availability and low cost, and they are an important cause of mortality and morbidity among young people. 3 The most common volatile substances that can be abused are aliphatic (butane, propane), aromatic (glues, lacquers, solvents) and halogenated hydrocarbons (spray paint, propellants).…”