Fatal poisoning by 111trichloroethane after prolonged survival

An 18 year old male was found with his head submerged in a bath of 1,1,1-TCE. He had respiratory and cardiac arrest with fixed, dilated pupils. Artificial respiration and cardiac massage were initiated about 15 minutes after his discovery and he was intubated and ventilated. Spontaneous respiration was resumed but he did not regain consciousness. Cerebral atrophy was evident on a CT scan carried out two months after the accident, and the protective eye reflex was absent on both sides suggesting a lesion of the occipital cortex, while the pupils remained dilated and inactive to light. There was restlessness and jerking of the limbs and trunk, and fixed flexion of all four limbs developed. There were recurrent urinary infections and the patient died 39 months after the accident. At postmortem examination the brain showed symmetrical infarction of the lenticular nuclei and of the occipital cortex, these changes possibly being the cause of the neurological manifestations during life. It was noted that the pattern of cerebral hypoxia was similar, although not identical to that found in carbon monoxide poisoning and suggested it may be specific for 1,1,1-TCE poisoning (Gresham and Treip, 1983).

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