title: Central nervous system effects in acute thallium poisoning.
abstract: We report the central nervous system manifestations, neuropsychological studies and brain magnetic resonance image (MRI) findings of two patients with acute thallium intoxication. Neurologically the patients suffered from confusion, disorientation, and hallucination in the acute stage, followed by anxiety, depression, lack of attention, and memory impairment, in addition to peripheral neuropathy. Neuropsychological tests revealed an impairment of memory function, including reversed digital span, memory registration, memory recall, memory recognition, similarity, proverb reasoning, and verbal fluency. High concentrations of thallium were found in the urine, blood, and drinking water of these two patients. Brain MRI showed lesions in the corpus striatum in one patient. During the follow-up periods, the clinical manifestations and neuropsychological studies showed a slowly progressive improvement, and a follow-up brain MRI 1.5 months later demonstrated a resolution of the lesions. We conclude that thallium intoxication might induce encephalopathy, and brain MRI studies demonstrated the acute-stage brain lesions in a severe intoxicated patient. In addition, neuropsychological tests also confirmed memory deficits, although the brain lesions in the corpus striatum might resolve.
authors.affiliation: Department of Neurology, Chang Gung Memorial Hospital and University, 199 Tung-Hwa North Road, Taipei, Taiwan.
authors.forename: Yu-Tai
authors.initials: YT
authors.lastname: Tsai
authors.forename: Chin-Chang
authors.initials: CC
authors.lastname: Huang
authors.forename: Hung-Chou
authors.initials: HC
authors.lastname: Kuo
authors.forename: Hsuan-Min
authors.initials: HM
authors.lastname: Wang
authors.forename: Wu-Shiun
authors.initials: WS
authors.lastname: Shen
authors.forename: Tung-Sheng
authors.initials: TS
authors.lastname: Shih
authors.forename: Nai-Shin
authors.initials: NS
authors.lastname: Chu
mesh_terms: D000931:Antidotes / Q000627:therapeutic use; D001921:Brain / Q000473:pathology; D002490:Central Nervous System / Q000187:drug effects* / Q000473:pathology; D002493:Central Nervous System Diseases / Q000139:chemically induced* / Q000473:pathology / Q000628:therapy; D002606:Charcoal / Q000627:therapeutic use; D004231:Diuresis; D004569:Electroencephalography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D013058:Mass Spectrometry; D008875:Middle Aged; D009437:Neuralgia / Q000139:chemically induced / Q000188:drug therapy; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D012867:Skin / Q000473:pathology; D013793:Thallium / Q000506:poisoning* / Q000652:urine
chemical_list: D000931:Antidotes; D002606:Charcoal; D013793:Thallium