Parkinsonism following chronic inhalation

A 49 year old female worked for 20 years in a leather product company. After this time she continued to work at home for a further 11 years until the onset of illness. At home the working environment was unprotected and uncontrolled. She used two glues; one used daily (containing n-hexane 85.5%) and the other used twice weekly (containing n-hexane 49%, acetone 5%, ethyl acetate 9%, trichloroethylene 7% and 1,2-dichloropropane 5%). She first developed rapidly progressing disease with severe akinesia, moderate hypertonia, mild parkinsonism and tremor in May and stopped using n-hexane products in November. Fourteen months after this she was confined to a wheelchair. Treatment with levodopa initially gave a good response but became less effective after a few weeks and dyskinesias were evident. However, she responded well to apomorphine. Homovanillic acid in the cerebrospinal fluid (CSF) was reduced; this is consistent with findings in other Parkinsonian patients. Electromyelography revealed mild axonal neuropathy (Pezzoli et al., 1989). The neuropathy improved after removal from n-hexane exposure, but there was rapid progression of parkinsonism and she died five years after the onset of symptoms (Pezzoli et al., 1995).

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