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Clinical Observation |

A Case of Severe Neurotoxicity Associated With Exposure to 1-Bromopropane, an Alternative to Ozone-Depleting or Global-Warming Solvents

Makoto Samukawa, MD; Gaku Ichihara, MD; Nobuyuki Oka, MD; Susumu Kusunoki, MD
Arch Intern Med. 2012;172(16):1257-1260. doi:10.1001/archinternmed.2012.3987.
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Health hazard alerts to 1-bromopropane, an alternative to ozone layer–damaging organic solvents, have been issued by some countries. Herein, we report a new case of 1-bromopropane–induced neurotoxicity. A 43-year-old male industrial worker developed muscle weakness, pain, numbness, and gait disturbance. Neurological examination indicated sensory ataxic neuropathy associated with mild impairment of upper motor neurons. He had used 1-bromopropane as a cleaning agent for metal parts at his workplace without appropriate protection. The serum bromide level was elevated at the onset of clinical manifestations. Histopathologic examination of sural nerve biopsy showed axonal damage. Under the tentative diagnosis of 1-bromopropane toxicity, he was kept away from exposure to the solvent. This resulted in gradual improvement of symptoms, recovery of motor function, and resolution of sensory deficits. The diagnosis of 1-bromopropane neurotoxicity in this case was based on details of the work environment, the clinical course, and laboratory and pathologic findings. To our knowledge, this is the first report that describes nerve biopsy findings in a human case.

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Figure. Microscopic examination showing axonal damage. A, Teased fibers of the sural nerve showed several myelin ovoids, suggestive of acute axonal damage. B, Toluidine blue staining of an epoxy resin–embedded section showed diffuse degeneration of axons, including swelling of axons and dark-colored or vanishing axons, among large fibers without demyelination and abnormal cell infiltration. No giant axon, which was frequently detected in the cases of n-hexan or acrylamide intoxication, was observed in this specimen.

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