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Medicine Aug 2021Acquired neuromyotonia syndrome is a rare form of peripheral nerve hyperexcitability syndrome. It is characterized by spontaneous and continuous muscle contractions....
RATIONALE
Acquired neuromyotonia syndrome is a rare form of peripheral nerve hyperexcitability syndrome. It is characterized by spontaneous and continuous muscle contractions. Acquired neuromyotonia syndrome is mainly observed in patients with autoimmune diseases or tumors, but it is a rare neurological clinical manifestation in patients with mercury poisoning.
PATIENT CONCERNS
A 56-year-old woman presented with continuous and involuntary muscle twitching in her legs for 2 months; it was accompanied by a burning sensation in the lower limbs, insomnia, fatigue, and night sweats. These symptoms did not disappear during sleep.
DIAGNOSES
Toxicological blood analysis via atomic fluorescence spectrometry revealed that the level of mercury was 0.07 μmol/L (normal level: <0.05 μmol/L). Her urinary mercury level measured using the cold atomic absorption method was 217.50 μmol/mol creatinine, which was considerably higher than the reference range (0-2.25 μmol/mol creatinine for people not in contact with mercury, 0-20 μmol/mol creatinine following long-term exposure). Upon further testing, a high level of mercury (10,572 mg/kg) was detected in the patient's cream. Accordingly, this patient was diagnosed with mercury poisoning.
INTERVENTIONS
Treatment with 2,3-dimercapto-1-propanesulfonic acid (DMPS) was initiated. Her urinary mercury level decreased to 9.67 μmol/mol creatinine, and her neuromyotonia syndrome and hyponatremia were relieved, with urine protein completely disappearing after 3 months of treatment.
OUTCOMES
After DMPS treatment, the clinical manifestations of the nervous system disappeared and electrolyte parameters returned to normal levels.
LESSONS
Acquired neuromyotonia syndrome is a rare disorder caused by the hyperexcitability of peripheral nerves, resulting in spontaneous and continuous muscle contraction. Mercury poisoning should be considered in patients with neuromyotonia syndrome. Early detection of mercury poisoning can prevent unnecessary examinations and treatments.
Topics: Brain; Electroencephalography; Female; Humans; Isaacs Syndrome; Magnetic Resonance Imaging; Mercury Poisoning; Middle Aged; Peripheral Nerves
PubMed: 34397926
DOI: 10.1097/MD.0000000000026910 -
Neurological Sciences : Official... Apr 2021
Topics: Humans; Isaacs Syndrome; Mercury Poisoning
PubMed: 33067679
DOI: 10.1007/s10072-020-04831-6 -
Anales de Medicina Interna (Madrid,... May 1996
Review
Topics: Female; Humans; Male; Mercury Poisoning; Occupational Diseases
PubMed: 8767865
DOI: No ID Found -
Lancet (London, England) Jun 1991
Topics: Humans; Mercury Poisoning; South America
PubMed: 1674314
DOI: 10.1016/0140-6736(91)93014-z -
Indian Journal of Pediatrics Jun 2023
Topics: Humans; Child; Child, Preschool; Mercury Poisoning; Mercury; Poisoning
PubMed: 36943632
DOI: 10.1007/s12098-023-04533-9 -
Journal of Biomedicine & Biotechnology 2012
Topics: Animals; Environmental Exposure; Humans; Mercury; Mercury Poisoning
PubMed: 22988426
DOI: 10.1155/2012/831890 -
European Journal of Pediatrics Jul 2010
Topics: Chelating Agents; Child; Female; Humans; Mercury Poisoning; Succimer; Unithiol
PubMed: 20195630
DOI: 10.1007/s00431-010-1170-2 -
Journal of the Neurological Sciences Dec 2023We had an opportunity to perform a general autopsy of a case with chronic organic mercury toxicosis in 2017. He had been engaged in synthesizing a variety of organic...
We had an opportunity to perform a general autopsy of a case with chronic organic mercury toxicosis in 2017. He had been engaged in synthesizing a variety of organic mercury compounds throughout the four years from 1966 and developed chronic organic mercury poisoning in 1969. Almost forty years on, he still remained to complain of persistent paresthesia at finger tips and tongue, and of narrowed visual field. Neurological examinations clarified a rise of two-point discrimination thresholds, a systemic increase of touch thresholds, constriction of the visual field caused by general visual depression, and sensorineural hearing loss while primary modalities of his somatic, visual, and auditory sensations were preserved. These symptoms and signs are characteristic of human organic mercury poisoning. Furthermore, he had difficulty in processing a lot of visual and auditory information at a time. His two-point discrimination thresholds and systemic elevation of touch thresholds were comparable to those of mild organic mercury poisoning cases. He had slight sensory ataxia, but not cerebellar ataxia. Brain [F]-2-fluorodeoxyglucose positron emission tomography analysis exhibited marked hypometabolism at bilateral postcentral gyrus, striate cortex, and superior temporal gyrus, but not the cerebellum. Histopathological studies revealed considerable decrease of granular neurons and neuronal networks in bilateral primary somatosensory, visual, and auditory cortices. Those characteristic brain lesions fairly explain increase of thresholds of somatic, visual, and auditory sensations, and degradation of integrating sensory information. It is noted that damages to the peripheral nervous system and the cerebellum were not detected and that his intellectual faculties were preserved.
Topics: Male; Humans; Mercury Poisoning, Nervous System; Brain; Mercury Poisoning; Nervous System Diseases; Autopsy
PubMed: 38000298
DOI: 10.1016/j.jns.2023.122802 -
Medical Hypotheses Apr 2001Autism is a syndrome characterized by impairments in social relatedness and communication, repetitive behaviors, abnormal movements, and sensory dysfunction. Recent... (Review)
Review
Autism is a syndrome characterized by impairments in social relatedness and communication, repetitive behaviors, abnormal movements, and sensory dysfunction. Recent epidemiological studies suggest that autism may affect 1 in 150 US children. Exposure to mercury can cause immune, sensory, neurological, motor, and behavioral dysfunctions similar to traits defining or associated with autism, and the similarities extend to neuroanatomy, neurotransmitters, and biochemistry. Thimerosal, a preservative added to many vaccines, has become a major source of mercury in children who, within their first two years, may have received a quantity of mercury that exceeds safety guidelines. A review of medical literature and US government data suggests that: (i) many cases of idiopathic autism are induced by early mercury exposure from thimerosal; (ii) this type of autism represents an unrecognized mercurial syndrome; and (iii) genetic and non-genetic factors establish a predisposition whereby thimerosal's adverse effects occur only in some children.
Topics: Autistic Disorder; Humans; Mercury Poisoning; Thimerosal
PubMed: 11339848
DOI: 10.1054/mehy.2000.1281 -
Journal of Medical Toxicology :... Oct 2020This is a case series of 3 children from a single family who developed symptomatic elemental mercury poisoning requiring hospitalization and chelation. The mercury...
This is a case series of 3 children from a single family who developed symptomatic elemental mercury poisoning requiring hospitalization and chelation. The mercury exposure primarily occurred in the home but the mercury was also tracked to one of their schools requiring environmental cleanup at both the home and school. The clinical assessment and management, as well as public health investigation and response, are discussed. There are many lessons learned in this difficult, often delayed, diagnosis. Early recognition of this environmental toxic exposure is essential. Communication between the clinicians and public health officials played a critical role. Public education prevented panic. Proper environmental sampling, and assessment and management of those exposed, were a few of the many challenges faced in this complicated case series.
Topics: Adolescent; Chelating Agents; Child; Diagnosis, Differential; Exanthema; Female; Fever; Hospitalization; Humans; Male; Mercury Poisoning; Predictive Value of Tests; Treatment Outcome
PubMed: 32572678
DOI: 10.1007/s13181-020-00792-6