thallium and Paresthesia

In cases of criminal thallium poisoning, forensic investigation is required to identify the amount and time of thallium exposure. Usually, blood and urine thallium levels are respectively used as biomarkers. Additionally, hair has the unique potential to reveal retrospective information. Although several studies have attempted to clarify how thallium is distributed in hair after thallium poisoning, none have evaluated the time course of changing thallium distribution. We investigated changes in the distribution of thallium in hair at different time points after exposure in five criminal thallotoxicosis patients. Scalp hair samples were collected twice, at 2.6 and 4.2-4.5months after an exposure incident by police. Results of our segmented analysis, a considerable amount of thallium was detected in almost all hair sample segments. The thallium exposure date estimated from both hair sample collections matched the actual exposure date. We found that determination of thallium amounts in hair samples divided into consecutive segments provides valuable information about exposure period even if a considerable time passes after exposure. Moreover, when estimating the amount of thallium exposure from a scalp hair sample, it is necessary to pay sufficient attention to individual differences in its decrease from hair.

Topics: Adult; Alopecia; Female; Forensic Toxicology; Hair; Humans; Japan; Male; Mass Spectrometry; Middle Aged; Paresthesia; Tea; Thallium; Young Adult

Information on the prognosis and electrophysiological follow-up of severe thallium poisoning is limited. We report two patients (mother and daughter) who were repeatedly exposed to thallium poisoning experienced hair loss, polyneuropathy, and visual impairment. Nerve conduction studies (NCSs), visual evoked potentials (VEP), brainstem auditory evoked potentials (BAEP) changes, and optical neuropathy developed within a few months latency after the first subjective signs. Normal findings of these electrophysiological methods in the first 2 weeks therefore led in one of our patients to exclusion of thallium as the cause of symptoms. Thallium poisoning was, however, later confirmed by toxicological analysis of blood and/or urine and feces in both the patients and in the microscopic hair analysis of the daughter. Both patients were treated with Prussian blue that increased the elimination of thallium in urine and feces. The hair loss was fully reversible. During a 2-year follow-up after the poisoning, polyneuropathy in the lower extremities improved substantially, but residual impairment in both motor and sensory function, NCSs, VEP, and BAEP remained. Additionally, severe asymmetrical vision impairment persists in both women, with central scotomata and impaired color discrimination in both eyes. Substantial improvement of their visual function is unlikely.

Topics: Adult; Alopecia; Animals; Antidotes; Crime; Dogs; Electroencephalography; Evoked Potentials, Auditory, Brain Stem; Evoked Potentials, Visual; Female; Ferrocyanides; Hair; Humans; Neurologic Examination; Optic Nerve Diseases; Pain; Paresthesia; Peripheral Nervous System Diseases; Poisoning; Sensation Disorders; Thallium; Vision Disorders; Vision Tests; Visual Acuity; Young Adult

In this study nine cases of thallium poisoning in a series of homicidal poisoning were analyzed in order to provide more information concerning thallium poisoning. It was found that the most common clinical feature of thallium poisoning was peripheral neuropathy and paraesthesia was more common than amyasthenia. Understanding of these clinical characteristics of thallium poisoning was helpful to early identification and differential diagnosis. Since the early administration of Prussian Blue, as a specific antidote for thallium poisoning, can substantially improve the prognosis, it is of great importance to establish a correct and early diagnosis.

Topics: Adult; Antidotes; Female; Ferrocyanides; Humans; Male; Middle Aged; Paresthesia; Poisoning; Thallium

Due to involvement of multiple systems, thallium poisoning is notorious for complexity and seriousness as symptoms of toxicity are non-specific and diverse. Alopecia and painful neuropathy are its cardinal features, others being gastrointestinal disturbances, encephalopathy, tachycardia, ataxia, hepatorenal and cardiac damage etc. We report a case of thallium poisoning who presented initially with gastrointestinal symptoms and later developed neurological features (peripheral neuropathy and delirium). Various diagnoses were entertained in this case and thallium poisoning was suspected only after he developed alopecia and neuropsychosis. He made a significant recovery by conservative management in spite of delay in diagnosis. We conclude that a high level of suspicion should be kept for thallium poisoning, especially in patients with painful, peripheral neuropathy and gastrointestinal symptoms which appear earlier than alopecia, since prognosis is more rewarding with early diagnosis, leading to complete recovery.

Topics: Abdominal Pain; Adult; Alopecia; Foodborne Diseases; Humans; Male; Paresthesia; Psychoses, Substance-Induced; Thallium

Topics: Aged; Female; Humans; Paresis; Paresthesia; Poisoning; Polyneuropathies; Thallium

Thallium poisoning is known for its diverse manifestations and these can delay the diagnosis if a clear history of poisoning is not forthcoming. A 42 year old man presented on the third day of illness with flaccid quadriparesis and paresthesia, which were confused with Guillain-Barré syndrome. Because of associated loose motions, skin lesions, and liver and kidney dysfunction arsenic poisoning was considered. In the second week he developed ophthalmoplegia, nystagmus, and neck tremor and later developed alopecia, and thallium poisoning was suspected. His serum thallium level on the 18th day of illness was 40 980 micro g/ml. He was subjected to haemodialysis, potassium supplementation, laxatives, and B complex supplementation. He showed significant improvement after haemodialysis and at three months he was able to walk with support. At six months of follow up he was independent for activities of daily living. Severe paresthesia, ophthalmoplegia, cerebellar and extrapyramidal signs, and alopecia are highly suggestive of thallium poisoning. Haemodialysis may be effective even in the third week of poisoning.

Topics: Adult; Alopecia; Humans; Male; Paresthesia; Quadriplegia; Renal Dialysis; Thallium

A male worker who handled thallium-containing raw material for glass manufacturing over a period of four years complained of alopecia, abdominal pain, diarrhea and tingling in the four extremities. Neurological examination of this patient revealed signs of mild glove-stocking-type polyneuropathy. Lower sensory nerve conduction velocity of the median nerve in the right hand than in the left hand suggested that conduction function in the dominant hand was reduced. The thallium content of the hair, as determined by an ICP-MS method, was 20 ng/g for the patient and 576 ng/g for his successor in the time of 32 months and 13 months, respectively, after they had ceased their glass production work. Those levels of thallium exposure were considered high, compared with the control levels so far reported. The clinical course of signs and symptoms, neurophysiological findings and thallium content of hair suggested that the patient suffered from chronic poisoning due to occupational exposure to thallium-containing dust.

Topics: Abdominal Pain; Adult; Alopecia; Diarrhea; Dust; Glass; Humans; Male; Muscle Weakness; Occupational Diseases; Occupational Exposure; Paresthesia; Thallium

A case of acute thallium poisoning presenting with sudden abdominal pain, paraesthesiae and irritability is described. The peripheral nervous system was later affected along with loss of hair and the development of streaks (Mee's lines) on the nails of the hands and feet. The diagnosis was established by thallium assays of blood and urine. Thallium was undetectable in the blood by day 70. The manifestations cleared in six months with symptomatic treatment only. We review the characteristics and differential diagnosis of thallium poisoning and stress the importance of a high index of clinical suspicion.

Topics: Adult; Alopecia; Colic; Humans; Irritable Mood; Male; Paresthesia; Thallium

Four young adults presented two days after one of them had received marzipan balls packaged in a box from an expensive candy manufacturer. Two ate one candy ball, while two others shared a third. The next day, variable gastrointestinal symptoms developed. On the third day, two patients developed painful paresthesiae of the hands and feet, an early but nonspecific clinical marker of thallium poisoning. A tentative diagnosis of thallium poisoning was made based on symptoms, and treatment was initiated. The remaining candies were radiographed. Metallic densities in the candies supported the diagnosis, and atomic absorption spectroscopy was used to quantitate thallium content. Each candy contained a potentially fatal dose. Five to seven days later, hypertension and tachycardia developed in the two patients who had ingested an entire candy. All patients developed alopecia but recovered without overt neurologic or other sequelae. While the diagnosis of thallium poisoning is often delayed until alopecia develops, an early diagnosis favors an effective treatment strategy.

Topics: Adult; Alopecia; Anemia; Antidotes; Candy; Charcoal; Chest Pain; Crime; Digestive System; Ferrocyanides; Food Contamination; Foodborne Diseases; Gastrointestinal Diseases; Humans; Hypertension; Paresthesia; Potassium Chloride; Radiography; Renal Dialysis; Sleep Initiation and Maintenance Disorders; Spectrophotometry, Atomic; Tachycardia; Thallium

The combination of rapid, diffuse alopecia, and neurologic and gastrointestinal disturbance is pathognomonic for thallium toxicity. The hair mount, showing a tapered or bayonet anagen hair with black pigmentation at the base, may be highly diagnostic before the onset of alopecia. We saw a 10-year-old boy who suffered from thallium poisoning.

Topics: Abdominal Pain; Acute Disease; Alopecia; Child; Humans; Male; Paresthesia; Seizures; Thallium