title: Cognitive dysfunction in a patient with long-term occupational exposure to ethylene oxide. Role of ethylene oxide as a causal factor.
abstract: This case illustrates a comprehensive approach to assessing causality in a woman with apparent cognitive dysfunction, as measured by neuropsychological testing, and a 10-year history of occupational exposure to ethylene oxide. The analysis included a multidisciplinary examination of the patient, which took place several years after the termination of her exposure. In addition, all of the patient's prior medical and psychiatric records were reviewed, as were the records of her employer to ascertain her exposure history. Our evaluation revealed a pattern of neuropsychological findings not consistent with nervous system damage secondary to an organic effect of ethylene oxide. A more likely causal hypothesis is adopted: the patient's apparent cognitive dysfunction had a psychiatric etiology. This case also illustrates the potential impact of a patient's involvement in legal proceedings related to claims of neurocognitive dysfunction.
authors.affiliation: Department of Pharmacology, Georgetown University Medical Center, Washington, DC 20007.
authors.forename: K L
authors.initials: KL
authors.lastname: Dretchen
authors.forename: N J
authors.initials: NJ
authors.lastname: Balter
authors.forename: S L
authors.initials: SL
authors.lastname: Schwartz
authors.forename: T J
authors.initials: TJ
authors.lastname: Boll
authors.forename: P
authors.initials: P
authors.lastname: Magrab
authors.forename: G F
authors.initials: GF
authors.lastname: Molinari
authors.forename: E P
authors.initials: EP
authors.lastname: Benedek
authors.forename: N
authors.initials: N
authors.lastname: Hershkowitz
authors.forename: J N
authors.initials: JN
authors.lastname: Fink
authors.forename: P
authors.initials: P
authors.lastname: Witorsch
mesh_terms: D000328:Adult; D002908:Chronic Disease; D003072:Cognition Disorders / Q000139:chemically induced* / Q000175:diagnosis / Q000523:psychology; D005027:Ethylene Oxide / Q000009:adverse effects*; D005260:Female; D006801:Humans; D009460:Neurologic Examination; D009483:Neuropsychological Tests; D009518:New York; D009784:Occupational Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000523:psychology; D016273:Occupational Exposure / Q000009:adverse effects*; D010556:Personality Tests; D014942:Workers' Compensation
chemical_list: D005027:Ethylene Oxide