title: Diffuse white matter lesions in carbon disulfide intoxication: microangiopathy or demyelination.
abstract: Long-term exposure to carbon disulfide (CS(2)) may induce diffuse encephalopathy with parkinsonism, pyramidal signs, cerebellar ataxia, and cognitive impairments, as well as axonal polyneuropathy. The pathogenic mechanisms of diffuse encephalopathy are unclear, although vasculopathy and toxic demyelination have been proposed. Recently, we have encountered a patient who developed headache, limb tremors, gait disturbance, dysarthria, memory impairment, and emotional lability after long-term exposure to CS(2). The brain magnetic resonance images (MRI) showed diffuse hyperintensity lesions in T(2)-weighted images in the subcortical white matter, basal ganglia, and brain stem. The brain computed tomography perfusion study revealed a diffusely decreased regional cerebral blood flow and prolonged regional mean transit time in the subcortical white matter and basal ganglion. To our knowledge, there have been few reports demonstrating diffuse white matter lesions in chronic CS(2) encephalopathy using brain MRI. In addition, the (99m)Tc-TRODAT-1 single photon emission computed tomography showed a normal uptake of the dopamine transporter, indicating a normal presynaptic dopaminergic pathway. We conclude that diffuse white matter lesions may develop after chronic exposure to CS(2), possibly through microangiopathy. In addition, CS(2) poisoning can be considered as one of the causes of chronic leukoencephalopathy.
authors.affiliation: Department of Neurology, Chang Gung Memorial Hospital and University, Taipei, Taiwan, ROC.
authors.forename: Mei-Chuan
authors.initials: MC
authors.lastname: Ku
authors.forename: Chin-Chang
authors.initials: CC
authors.lastname: Huang
authors.forename: Hung-Chou
authors.initials: HC
authors.lastname: Kuo
authors.forename: Tzu-Chen
authors.initials: TC
authors.lastname: Yen
authors.forename: Chi-Jen
authors.initials: CJ
authors.lastname: Chen
authors.forename: Tung-Sheng
authors.initials: TS
authors.lastname: Shih
authors.forename: Ho-Yuan
authors.initials: HY
authors.lastname: Chang
mesh_terms: D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology*; D001931:Brain Mapping; D002246:Carbon Disulfide / Q000506:poisoning*; D002560:Cerebrovascular Circulation; D003711:Demyelinating Diseases / Q000209:etiology*; D005073:Evoked Potentials, Somatosensory / Q000502:physiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009431:Neural Conduction; D009460:Neurologic Examination; D009483:Neuropsychological Tests; D009784:Occupational Diseases / Q000139:chemically induced* / Q000175:diagnosis; D016273:Occupational Exposure; D011041:Poisoning / Q000209:etiology*; D013995:Time; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D014057:Tomography, X-Ray Computed
chemical_list: D002246:Carbon Disulfide