title: Ethylene oxide neurotoxicity: a cluster of 12 nurses with peripheral and central nervous system toxicity.
abstract: Ethylene oxide (EO) is commonly used to sterilize heat-sensitive products used by hospital patients and personnel. Ethylene chlorohydrin (EC), a by-product, is considered highly toxic. We report a cluster of 12 operating-room nurses and technicians who developed symptoms after a 5-month exposure to high levels of EO and EC in disposable surgical gowns. All patients reported a rash on the wrist where contact was made with the gowns, headaches, and hand numbness with weakness. Ten of 12 patients complained of memory loss. Neurologic evaluation revealed neuropathy on examination in nine of the 12 patients, elevated vibration threshold in four of nine, abnormal pressure threshold in 10 of 11, atrophy on head MRI in three of 10, and neuropathy on conduction studies in four of 10. Neuropsychological testing demonstrated mild cognitive impairment in four of six patients. Sural nerve biopsy in the most severely affected patient showed findings of axonal injury. Several patients in this group display signs of peripheral and CNS dysfunction following exposure to EO. Possible mechanisms of neurotoxicity include direct exposure of peripheral nerves through cutaneous absorption and central involvement through inhalation and vascular dissemination. The frequency of central and peripheral nervous system symptoms, supported by objective testing in these EO-exposed patients, suggests other healthcare personnel may be at similar risk.
authors.affiliation: Department of Neurology, Indiana University School of Medicine, Indianapolis, USA.
authors.forename: A
authors.initials: A
authors.lastname: Brashear
authors.forename: F W
authors.initials: FW
authors.lastname: Unverzagt
authors.forename: M O
authors.initials: MO
authors.lastname: Farber
authors.forename: J M
authors.initials: JM
authors.lastname: Bonnin
authors.forename: J G
authors.initials: JG
authors.lastname: Garcia
authors.forename: E
authors.initials: E
authors.lastname: Grober
mesh_terms: D000328:Adult; D001706:Biopsy; D002493:Central Nervous System Diseases / Q000139:chemically induced* / Q000175:diagnosis; D016000:Cluster Analysis; D003875:Drug Eruptions / Q000175:diagnosis; D005027:Ethylene Oxide / Q000506:poisoning*; D005073:Evoked Potentials, Somatosensory; D006225:Hand; D006261:Headache / Q000139:chemically induced; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009135:Muscular Diseases / Q000139:chemically induced; D009431:Neural Conduction; D009460:Neurologic Examination; D009498:Neurotoxins / Q000506:poisoning*; D009726:Nurses; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000473:pathology; D012678:Sensation Disorders / Q000139:chemically induced; D013497:Sural Nerve / Q000473:pathology
chemical_list: D009498:Neurotoxins; D005027:Ethylene Oxide