Fonte Rodolfo, Edallo Alessia, Candura Stefano M
Division of Occupational Medicine, Salvatore Maugeri Foundation, Work and Rehabilitation, IRCCS, Scientific Institute of Pavia, Via Ferrata 8, 1-27100 Pavia, Italy.
Ind Health. 2003 Jan;41(1):43-7. doi: 10.2486/indhealth.41.43.
A 70-year-old man developed a slowly progressive cerebellar syndrome after having been exposed to carbon disulfide (CS2) in a viscose rayon plant for 27 years. Ataxia, dysmetria, dysarthria and adiadochokinesia appeared 7 years after retirement from work (at age 54), and were later accompanied by cognitive deterioration, dysmnesia, spatio-temporal disorientation, emotional lability, and paranoid-obsessive disturbances. Brain computed tomography (CT) and magnetic resonance imaging (MRI) showed advanced global cerebellar atrophy, and a picture of less severe cerebrocortical atrophy. The case illustrates the possibility of chronic toxic encephalopathy among patients with previous long-term exposure to CS2. In such instances, cerebellar damage may develop as an exceptional, delayed manifestation of neurotoxicity: brain imaging techniques can significantly contribute to the diagnosis and follow-up, in addition to occupational anamnesis and neuropsychiatric evaluation. The patient presented also serves as a remainder that neurodegenerative disorders of apparently unknown origin sometimes derive from occupational toxic exposures suffered in the past. The clinical manifestations may appear several years after retirement from work, when the effects of toxic damage combine with age-related neuronal loss to overcome the brain functional reserve.
一名70岁男性在一家粘胶纤维厂接触二硫化碳（CS2）达27年后，出现了缓慢进展的小脑综合征。共济失调、辨距不良、构音障碍和轮替运动障碍在其退休7年后（54岁时）出现，随后伴有认知功能减退、记忆障碍、时空定向障碍、情绪不稳定以及偏执强迫性障碍。脑部计算机断层扫描（CT）和磁共振成像（MRI）显示严重的全小脑萎缩以及不太严重的脑皮质萎缩。该病例说明了既往长期接触CS2的患者发生慢性中毒性脑病的可能性。在这种情况下，小脑损伤可能作为神经毒性的一种特殊的延迟表现而出现：除职业病史和神经精神评估外，脑成像技术对诊断和随访有显著帮助。该患者也提醒人们，一些病因不明的神经退行性疾病有时源于过去遭受的职业性毒物暴露。临床表现可能在退休数年之后出现，此时毒性损伤的影响与年龄相关的神经元丢失相结合，超过了大脑的功能储备。
