Peripheral neuropathy following chronic inhalation

A 60 year old male was admitted to hospital in 1979 with a five year history of progressive lower extremity weakness and sensory loss. He had worked as a janitor for an adhesive tape manufacturer. The company had used the solvents n-hexane and toluene from February to July 1971. Use of n-hexane was stopped after publication of the first report of n-hexane neuropathy in the United States (Herskowitz et al., 1971). However, the patient found that n-hexane was useful for removing glue stains and he had sequestered a container of it which he used to clean table tops in the laboratory. He used gloves during this process and spent less than two hours daily cleaning the laboratory area. He did not use n-hexane anywhere else. In 1973 the safety manager discovered that he was using n-hexane and measured the solvent content of the air in the laboratory on five separate occasions. The average concentration was 325 ppm with a single peak of 450 ppm. He was permitted to continue using the solvent as the concentration never exceeded 500 ppm, which, at the time, was the TLV for n-hexane.

He first noticed weakness and numbness of the lower limbs in 1974 and over the next few years the numbness progressed up to the calves. In 1976 he began to have difficulty in walking and, on retirement in 1977, was unable to walk without assistance. On examination he had marked lower extremity weakness with distal upper and lower extremity sensory loss. Electromyography indicated denervation in distal lower extremity muscles. By 1979 he had moderate subjective improvement in lower extremity sensation but still had difficulty in walking. Sensory nerve responses were delayed in the upper and lower extremities. A sural nerve biopsy showed myelinated and unmyelinated enlarged axons. Normal axons were surrounded by a thin myelin sheath. The swollen axons were distended by massive accumulations of neurofilaments; some were surrounded only by a single basement membrane. The slow onset of this patient's illness was thought to be due to the relatively low level of exposure to n-hexane (Ruff et al., 1981). A more recent anecdotal report has suggested that low level exposure to n-hexane (2.8-28 ppm) for 30 years may have caused neuropathy (Barrgard et al., 1991).

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