Reversible cerebral and brain stem dysfunction in n: Hexane neuropathy

Abstract

A 18-year-old male, screen printer by profession developed sensory motor polyneuropathy, change in his behavior, bilateral 6 th and 7 th cranial nerve palsies, down beat nystagmus and cerebellar dysarthria. He had bilaterally prolonged P100 latency; left: 137 ms; right: 144 ms. P 37 was not recordable on either side while N 20 was normal. The inter latency difference between Ipsilateral R2 and Contralateral R2 was 6.15 ms, on the left side and normal on the right side. In the follow-up, there was normalization of the blink reflex study, improvement in P100 latency [left: 114 ms; right: 120 ms.] but worsening of peripheral nerve conductions. The sequential clinical recovery was of the behavioral dysfunction, down beat nystagmus, 6 th nerve, 7 th nerve involvement and ataxia, in that order. Sural nerve biopsy showed loss of large diameter myelinated fibers.

Keywords

• 6 th and 7 th nerve palsy
• blink reflex
• central nervous system involvement
• down beat nystagmus
• n- Hexane neuropathy