Central nervous system effects in acute thallium poisoning

Clinical Manifestations and Management of Acute Thallium Poisoning

“…Each patient presented with common symptoms of thallium poisoning, including gastroenteritis, polyneuropathy and dermatological changes, as reported previously [1,6,7,8,9,10,11,12,13,14]. Recently, both industrial and intentional thallium poisoning have become relatively rare due to the strict regulation of thallium utilization.…”

“…Secondary riboflavin deficiency can then result in dermatitis, alopecia, Mees’ lines and neuropathy [1, 3, 16, 17]. The cardiovascular system is the main target of thallium toxicity in early stages, and produces tachycardia and hypertension [1, 6, 8, 12, 14, 15]. Hepatic toxicity also occurs [7, 8, 12, 13].…”

“…Central nervous system symptoms may include somnolence, hallucinations, tremor, ataxia, athetosis, seizures or even death [1, 8, 9, 14, 15, 18]. Paresthesia, dysesthesia, allodynia and severe pain are the most common features of peripheral nervous system involvement [19].…”

“…Patient 1 had the most severe symptoms, consistent with his high body thallium burden. Our findings suggest that peripheral nervous system symptoms, similar to central nervous system symptoms, may be dose dependent, with higher thallium burdens correlating with more severe disease [8, 9]. …”

“…Sural nerve biopsy revealed a loss of axons, active axonal degradation, and increased endoneurial collagen and inflammatory cell infiltration, and the Kulchitsky Pal stain showed demyelination [5, 7]. Hypo- [5, 6, 9, 11, 14, 15, 20], hyper- [8] or normal [12] deep tendon reflexes could exist in patients with thallium intoxication. The reason for this remains unclear.…”