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Environmental Medicine Integrating a Missing Element into Medical Education (1995) / Chapter Skim
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Case Study 45: Trimethyltin Encephalopathy
Pages 767-771

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From page 767...
... Triethyltin intoxication has been used as an experimental model of myelinopathies, neurodegenerative disorders, and cerebral edema, while trimethyltin has been used in the investigation of hippocampal lesions, kainic acid neurotoxicity, and minimal brain dysfunction and to elucidate the cytoarchitecture of the brain and the neuropathologic findings of limbic seizure activity.) 2 Although there are many reports from studies on laboratory animals on the neuropathologic and behavioral changes induced by trimethyltin,3 there have been few reports on such effects in humans4~7 and those that do exist are confounded by exposure to chemicals other than tin, poor exposure data, or incomplete clinical follow up (Td~le 1)
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From page 768...
... Asymmetric 3- to 4-Hz delta waves developed on the left side with drowsiness or hyperventilation. Neuropsychological testing revealed significant impairment in new learning of verbal and visuospatial information on the Wechsler Memory ScaleRevised (WMS-R)
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From page 769...
... Neuropsychological assessment (including WAIS-R, Ravens Advanced Progressive Matrices, Repeated Motor Programs, Trail Making Test, Wisconsin Card Sorting Test, 769 Hand Grip Strength, Finger Tapping, Grooved Pegboard, Boston Naming Test, Controlled Word List Generation, Writing Sample, Boston Visuospatial Quantitative Battery Constructions, Rey-Osterreith Complex Figure, WMS [Revised] , California Verbal Learning Test, Milner Faces, Albert's Famous Faces, Minnesota Multiphasic Personality Inventory, and Profile of Mood States)
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From page 770...
... Likewise, his dysphoric mood is typical of mood changes associated with left hemisphere damage.24~27 The lateralization of mood and memory changes to the left cerebral hemisphere is consistent with both the patient's EEG findings and findings previously reported in patients with left temporal foci excision and seizures not attributable to toxic exposures.28 The only available human autopsy report described a man who died of pulmonary effects secondary to high exARCH NEUROI1VOE 50, DEC 1993 1323 ENVIRONMENTAL MEDTCINE
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From page 771...
... Proposed mechanisms include release of endogenous excitotox~ns from the heavy metal~ontaining pathways of the hippocampus,29 elevated extracellular glutamate levels,30 hyperammonemia,3' decreased ~y-aminobutyr~c acid concentration,32 inhibition of Ca2+-ATPase in a concentration-dependent manner thereby interfering with calcium pump and other cAMP (adenosine 3': 5'-cyclic phosphate) -mediated processes in the brain,33 or a reduction in the hippocampal zinc concentration, possibly leading to mossy fiber disinhibition and subsequent hyperexcitation of the hippocampal electrical arcuitry.334 Tnmethyltin Is an intermediate by-product in the production of other more commonly used tin products.3 It, thus, so constitutes art occupational hazard for some groups, especially chemists who often seem unaware of the inherent dangers.35 This article documents the acute and long-term neurotox~c effects of exposure in a young man.
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Key Terms

  • below expectation
  • memory defects
  • delayed recall
  • california verbal
  • drs feldman

  • learning test
  • verbal learning
  • neuropsychological testing
  • central nervous
  • serial neuropsychological

  • time course
  • neuropsychological test
  • evoked potentials
  • neurotoxic effects
  • personality inventory

  • mesial temporal
  • behavioral changes
  • wechsler memory
  • partial seizures
  • five months

  • verbal memory
  • wechsler adult
  • organotin compounds
  • cerebral edema
  • minnesota multiphasic

  • deep depression
  • trimethyltin induced
  • memory quotient
  • urinary levels
  • permanently disabled


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