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Spontaneous intracranial hypotension — SCE Neurology MCQ

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HardCSF DisordersSpontaneous intracranial hypotensionSCE Neurology

A 44-year-old industrial painter develops executive dysfunction, dysarthria and ataxia that repeatedly improve during prolonged holidays. MRI shows symmetric confluent periventricular and subcortical white-matter hyperintensity with relative sparing of U-fibres and T2 hypointensity of the thalami. Which exposure is most likely?

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Correct answer: E — Occupational exposure to toluene-containing solvents

Explanation lettering: E = shown as A · C = shown as B · A = shown as C · B = shown as D · D = shown as E

D is correct: chronic organic-solvent, particularly toluene, neurotoxicity causes neurobehavioural dysfunction, ataxia and brainstem features with diffuse symmetric leukoencephalopathy, relative U-fibre sparing and sometimes basal-ganglia or thalamic T2 hypointensity. Improvement away from work is a powerful exposure clue. Nitrous oxide preferentially injures posterior spinal columns and peripheral nerves. Methanol causes acute optic and putaminal injury. Carbon monoxide classically injures globus pallidus and may cause delayed leukoencephalopathy after an acute toxic event.

Reference: Neurotoxicology: a clinical systems-based review: https://pn.bmj.com/content/24/5/357