Poungvarin N
Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
J Med Assoc Thai. 1991 Jul;74(7):296-300.
The first patient of multifocal brain damage due to lacquer sniffing was reported in Thailand. He was a 24-year-old man who had a 5 year history of lacquer sniffing (toluene abuse). He had difficulty in walking and had tremor for 1 year which became progressively worse and he was finally confined to bed. Examination revealed marked cerebellar signs of both upper and lower extremities with scanning speech. Five of his friends who were lacquer abusers also had similar symptoms and were confined to bed. Investigations showed marked atrophy of both cerebellar hemispheres, vermis, brainstem and less atrophy of both cerebral hemispheres in both computerized brain scanning and magnetic resonance imaging. Diffuse toxic demyelination of white matter and excess iron deposition over both thalami, basal ganglia and cerebral cortex were demonstrated on magnetic resonance imaging. Brainstem evoked response showed abnormal response of both sides. Nerve conduction velocity, electromyographic study and electroencephalogram were normal. Psychometric tests revealed dull normal or below average IQ-test of 82. He was admitted for 2 months with gradual recovery of neurological deficits. After six months of abstinence from lacquer and daily physical rehabilitation. This report of toluene abuse is not only public health problem but also reflects the socioeconomic status as well as political unawareness of this condition in the Thai community.
泰国报道了首例因吸食漆料导致多灶性脑损伤的患者。他是一名24岁男性，有5年吸食漆料（甲苯滥用）史。他行走困难且震颤1年，病情逐渐加重，最终卧床不起。检查发现双上肢和双下肢有明显的小脑体征及吟诗样言语。他的5名漆料滥用朋友也有类似症状并卧床不起。计算机脑扫描和磁共振成像检查均显示双侧小脑半球、小脑蚓部、脑干明显萎缩，双侧大脑半球萎缩较轻。磁共振成像显示白质弥漫性中毒性脱髓鞘以及双侧丘脑、基底神经节和大脑皮质铁沉积过多。脑干诱发电位显示双侧反应异常。神经传导速度、肌电图检查和脑电图均正常。心理测试显示智商测试结果为82，属迟钝正常或低于平均水平。他住院2个月，神经功能缺损逐渐恢复。在戒除漆料并每日进行身体康复治疗6个月后。这份关于甲苯滥用的报告不仅是一个公共卫生问题，也反映了泰国社区的社会经济状况以及对这种情况的政治忽视。
