title: [Parkinsonism secondary to ethylene oxide exposure: case report].
abstract: Ethylene oxide is a gas widely used in the production of industrial chemicals. It is also used to sterilize heat-sensitive medical supplies. Previous reports of acute and chronic exposure have described neurotoxic effects like peripheral neuropathy and cognitive impairment. We describe a pure parkinsonian syndrome following acute ethylene oxide intoxication. A 39-years-old male was referred to our Movement Disorders Clinic for evaluation of a parkinsonian syndrome. He was acutely exposed to ethylene oxide four years before and remained comatose for three days, and gradually regained consciousness. At that time he showed a global parkinsonian syndrome including bradykinesia, rigidity and rest tremor, with a severe motor disability; no other neurological disorders were found. The symptomatology was partially controlled with biperidene and levodopa plus carbidopa. Two years later he developed L-dopa induced dyskinesias. Four years after the intoxication he was evaluated at our clinic. General examination showed no abnormalities. Neurologic examination revealed a normal mental status. Motor evaluation disclosed moderate bradykinesia, rigidity and rest tremor, shuffling gait, poor facial mimic, stooped posture, and his speech was low and monotonous; deep tendon reflexes were brisk. The Hoehn-Yahr disability score was degree IV. Routine laboratory and radiological exams showed results within normal limits. The CSF examination was normal. Brain computed tomography and magnetic ressonance were normal. A trial with bromocriptine and levodopa plus carbidopa did not improve dyskinesia, and he was put on a schedule including amantadine and biperidene with improvement to grade III in Hoehn-Yahr scale. In the present case there was a clear relation between the acute exogenous intoxication and irreversible parkinsonism.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Grupo de Estudos de Distúrbios do Movimento da Divisão de Clínica Neurológica, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, (FMUSP), Brasil.
authors.forename: E R
authors.initials: ER
authors.lastname: Barbosa
authors.forename: L R
authors.initials: LR
authors.lastname: Comerlatti
authors.forename: M S
authors.initials: MS
authors.lastname: Haddad
authors.forename: M
authors.initials: M
authors.lastname: Scaff
mesh_terms: D000328:Adult; D005027:Ethylene Oxide / Q000506:poisoning*; D006801:Humans; D008297:Male; D010302:Parkinson Disease, Secondary / Q000139:chemically induced* / Q000188:drug therapy
chemical_list: D005027:Ethylene Oxide
vernacular_title: Parkinsonismo secundário a exposição a óxido de etileno. Registro de caso.