A 44 year old woman previously in good health, developed perioral tingling and a burning sensation on her tongue, accompanied by discomfort in her hands and feet. The oral and hand symptoms disappeared quickly after removal from work, but she was left with sensations of burning and cramping in her feet, which made it difficult to walk or stand for prolonged periods of time. She had no history of diabetes mellitus or excessive alcohol ingestion or any other conditions associated with peripheral neuropathy.
Approximately 18 months prior to the development of her symptoms, she had begun work as a hydraulic pump dismantler and parts cleaner. She estimated that approximately half of her daily work activities involved contact with a degreasing solvent (1,1,1-TCE with 1-5% dimethylene ether), with the exposure occurring by both inhalation and skin contact. Although she wore protective gloves she said that they often leaked, as did her respirator. There was no other exposure at work to agents known to cause peripheral neuropathy, and no history of prior occupational exposure to such agents.
On examination she had diminished vibration sense in the big toes bilaterally, as well as absent position sense. Tendon reflexes were normal, and there was no muscle atrophy or demonstrable muscle weakness. Clinical examination did not indicate any evidence of hepatic, cardiac, or CNS abnormalities. The evoked potential studies were normal, and the initial neurophysiological studies indicated a normal electromyogram. The initial sensory nerve conduction tests indicated reduced amplitudes of sural sensory responses bilaterally and normal nerve conduction velocities and sensory latencies consistent with a toxic axonopathy. Within 2 months after removal from work, she began to notice improvement in lower limb symptoms of paraesthesia and cramping, and six months after removal her symptoms had resolved almost entirely. Her physical examination at the time was normal except for a very slight reduction of vibration sensation in the big toes bilaterally. Repeat nerve conduction studies seven months after removal from exposure demonstrated improved sural sensory amplitudes and no other changes, compared with the initial studies. On the basis of her nerve conduction studies and the previous reports of peripheral neuropathy following 1,1,1-TCE exposure in degreasing operators, the peripheral neuropathy claim was accepted as being work-related by the workers' compensation board in her province (House et al., 1994).
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