Severe dopaminergic pathways damage in a case of chronic toluene abuse

Received 26 November 2008; received in revised form 29 June 2009; accepted 4 July 2009.

Abstract

Introduction

Toluene toxicity primarily affects central nervous system white matter, causing a characteristic brain MRI pattern.

Case report

A toluene addicted man, after an abstinence period and a treatment with neuroleptics, presented with severe worsening of preexisting generalized tremor, opsoclonus, dysarthria, gait inability, jerky tendon reflexes and behaviour disorders. Magnetic resonance imaging showed mild leukoencephalopathy and hypointensities in deep gray matter nuclei. The DaT-scan revealed a decrease in presynaptic dopamine reuptake.

Conclusion

Clinical and neuroradiological findings and the possible sensitivity to neuroleptics indicate dopaminergic impairment. Our case suggests that chronic toluene abuse causes presynaptic dopaminergic depletion.

Keywords: Toluene, Leukoencephalopathy, DaT-scan, Neuroleptic malignant syndrome, Dopamine

a Department of Neurology, Eginition Hospital, Medical School, Athens National University, Athens, Greece

b Department of Psychiatry, Eginition Hospital, Medical School, Athens National University, Athens, Greece

c Nuclear Medicine Division, Radiology Department, Aretaieio Hospital, Medical School, Athens National University, Athens, Greece

Corresponding author at: Department of Neurology, Eginition Hospital, University of Athens, 74, Vassilissis Sofias Avenue, 11528 Athens, Greece. Tel.: +30 2107289404/6977446034; fax: +30 2107216474.

PII: S0303-8467(09)00175-9

doi:10.1016/j.clineuro.2009.07.007

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