Case Reports

A 60 year old man was exposed to diisobutyl ketone in his job as a laboratory technician. The solvent was heated to 367 °C and used under pressure. After about one month (May to June 1985) he developed severe headaches and vision loss. He was referred for neurological and neuropsychological evaluation on several occasions for headaches. Neurological evaluation revealed peripheral neuropathy. A CT scan in November 1985 was normal. An MRI was performed in January 1986 and showed numerous small, discrete focal lesions scattered throughout the white matter and bilaterally in the upper pons. In August 1986 MRI showed multiple focal areas of high signal intensity in the white matter, some in the periventricular white matter and other areas midway between the ventricles and cortex. In May 1987 there were multiple small focal lesions deep in the white matter of both cerebral hemispheres and the pons. There appeared to be some improvement compared to the previous results. In a battery of neuropsychological tests he was normal for tests on attention and executive function but was below expectation for verbal, language and memory tests. His wife reported that he was irritable and apathetic, but he denied changes in mood. Results suggested some affective changes with deficits in manual motor speed, verbal fluency, visuospatial organisation and short-term memory (White et al., 1993). However, there was no measurement of exposure concentrations of diisobutyl ketone or evaluation of exposure to any other chemicals in the workplace. Consequently, the cause of the neurological effects is unclear.

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