Neurobehavioral Toxicology: Neurological And

This book, the second of three volumes, concentrates on peripheral nervous system disorders. It looks at the effects of neurotoxicants on nerve, muscle, and the neuromuscular junction. It builds on the scientific principles outlined in Volume I by looking at the application of the methods discussed, particularly in terms of the evaluation and diagnosis of individual patients and the related process of establishing causation.

James W. Albers, MD, PhD is a Neurologist who specializes in neuromuscular disorders Stanley Berent, PhD is a Psychologist with specialties in Clinical Psychology and Clinical Neuropsychology

Contents of Volumes I and III

ix

Preface to Volume II

xvii

Acknowledgments

xix

Disclosures

xx

Clinical and Electrodiagnostic Evaluations of the Peripheral Nervous System

257

(72)

Examination of the peripheral nervous system

258

(60)

Clinical examination in selected conditions

259

(8)

Electromyography (EMG) examination

267

(21)

Developing the differential diagnosis using clinical and EMG results

288

(16)

Sources of error

304

(14)

Summary

318

(11)

Industrial and Environmental Agents

329

(100)

Selected presentations

330

(78)

Acrylamide

330

(7)

Arsenic

337

(9)

Botulinum toxin

346

(5)

Carbon disulfide

351

(5)

Elemental mercury

356

(17)

Lead

373

(11)

Organophosphorus compounds

384

(8)

Thallium

392

(5)

Trichloroethylene

397

(11)

Summary

408

(21)

Medications and Substances of Abuse

429

(96)

Selected presentations

431

(78)

Cisplatin

431

(5)

Colchicine

436

(8)

Dapsone

444

(7)

Disulfiram

451

(4)

Ethyl alcohol

455

(6)

n-Hexane

461

(8)

Lipid-lowering medications (HMG-CoA reductase inhibitors)

469

(10)

Nondepolarizing neuromuscular blockade and corticosteroids

479

(7)

Nitrofurantoin

486

(4)

Penicillamine

490

(6)

l-Tryptophan

496

(7)

Vaccination -- A/New Jersey (swine flu) vaccine

503

(6)

Summary

509

(16)

Conditions Which Sometimes Mimic Peripheral Nervous System Disease

525

(50)

The influence of aging on clinical and electrodiagnostic examinations

526

(5)

Neurologic examination

526

(3)

Electrodiagnostic examination

529

(2)

The influence of anthropometric factors on the clinical and electrodiagnostic examinations

531

(11)

Neurologic examination

531

(2)

Electrodiagnostic examination

533

(7)

Nerve biopsy results

540

(2)

Physiologic or emotional conditions producing symptoms suggestive of neuromuscular disease

542

(9)

The influence of normal physiology on the nervous system

543

(5)

Functional or psychological factors

548

(3)

Non-neurologic conditions suggestive of peripheral neuropathy or myopathy

551

(13)

Symptoms due to connective tissue or skin

551

(6)

Vascular disorders

557

(1)

Metabolic/endocrine disorders mimicking neuropathy

558

(2)

Disorders of the spinal cord and nerve roots mimicking peripheral neuropathy

560

(4)

Conditions suggesting myopathy or defective neuromuscular transmission

564

(3)

Case presentation

565

(2)

Summary

567

(8)

Consequences of an Incomplete Differential Diagnosis

575

(78)

Case presentations

575

(65)

Lead-exposed painter with arm weakness

575

(8)

Patient with acute sensory loss and ethylene oxide exposure

583

(6)

Patient with an acute reaction to an organophosphorus pesticide

589

(10)

A woman with silicone breast implants and diffuse neuromuscular symptoms

599

(8)

Husband and wife with mushroom poisoning

607

(7)

Patient with acute abdominal pain and neuropathy

614

(12)

Chemist with myelopathy and neuropathy

626

(6)

Machinist with suspected solvent-induced toxic neuropathy

632

(8)

Summary

640

(13)

Issues and Controversies Involving the Peripgheral Nervous System Evaluation

653

(62)

Neurotoxic peripheral neuropathies: Typical and atypical distributions

654

(7)

Symmetry versus multifocal presentations

654

(3)

Proximal versus distal presentations

657

(1)

Upper extremity more than lower extremity distributions

658

(1)

Possible explanations for atypical neurotoxic distributions

658

(3)

Subclinical toxic neuropathy

661

(15)

Subclinical neuropathy identified on electrodiagnostic testing

662

(14)

Delayed effect neurotoxicity

676

(5)

Identifying a normal study: Adequacy of the clinical and electrodiagnostic results

681

(10)

What is normal?

682

(2)

Issues involving interpretation of the EMG evaluation

684

(7)

What if the electrophysiology results are normal?

691

(3)

Patients with small fiber polyneuropathy

691

(3)

Establishing causation in clinical neurotoxicological investigations

694

(10)

Inadvertent or unrecognized confounding due to selection bias

695

(3)

Potential misinterpretation of results due to pseudocausation

698

(4)

Adverse effects inferred by correlational analyses

702

(2)

Controversial neurotoxic disorders involving the peripheral nervous system

704

(4)

Summary

708

(7)

Postscript Volume II

715

(8)

Appendix to Volume II

723

(2)

Subject index

725

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Neurobehavioral Toxicology: Neurological And Neuropsychological Perspectives, Peripheral Nervous System

Summary

Author Biography

Table of Contents

Supplemental Materials