Elsevier

Neurologic Clinics

Volume 18, Issue 3, 1 August 2000, Pages 665-680
Neurologic Clinics

BASAL GANGLIA NEUROTOXINS

https://doi.org/10.1016/S0733-8619(05)70217-6Get rights and content

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MANGANESE

Chronic manganese intoxication was recognized by Couper in the early 19th century. In 1837, he described a distinctive neurologic syndrome among several workers in a manganese ore crushing mill.18 Couper recognized that this syndrome is the result of inhaling manganese dioxide-containing dust particles. Subsequent work confirmed Couper's clinical description and his recognition of the occupational nature of chronic manganese intoxication. The great majority of manganese, some millions of tons

CYANIDE

Cyanide intoxication results from accidental exposures and deliberate exposures in suicide and homicide attempts.35 There are multiple possible sources of cyanide. Cyanide compounds, such as hydrocyanic acid, potassium cyanide, and sodium cyanide, are used in industrial processes. Cyanide gas may arise from burning polyurethanes, wool, silk, nitrocellulose, and synthetic rubbers. Cyanide may be produced in vivo as a result of biotransformation of cyanogenic compounds such as nitriles, of which

CARBON DISULFIDE

Like manganism, carbon disulfide intoxication is a product of the industrial revolution. Carbon disulfide was used originally in the 19th century in the manufacture of rubber.61 In the 20th century, the widest use of carbon disulfide was in the manufacture of rayon fibers and it was used as a grain fumigant, leading to significant exposures among farmers and silo workers.53, 61 Carbon disulfide was a significant source of morbidity among exposed workers.61 Several neurologic manifestations were

HYDROGEN SULFIDE

Hydrogen sulfide is produced by bacterial decomposition of natural products, natural chemical processes such as volcanic eruption, and is a byproduct of several industrial processes. Hydrogen sulfide is a clear foul smelling gas that produces mucosal irritation, pulmonary edema, and central nervous system toxicity.35 The mechanism of neurotoxicity of hydrogen sulfide is thought to be similar to that of cyanide, inhibition of Fe3+ containing enzymes, notably cytochrome oxidase. Acute hydrogen

METHANOL

Methanol (methyl alcohol) is available widely in the form of deicers, paint removers, carburetor cleaning fluids, and as a solvent in laboratories. Methanol intoxication results most commonly from accidental or deliberate oral ingestion, but toxic amounts can be absorbed transdermally or by inhalation.23 Symptoms of methanol intoxication appear usually with a lag time of several hours after exposure because the proximate cause of methanol toxicity is not methanol itself but its metabolite,

CARBON MONOXIDE

Carbon monoxide is an odorless, colorless gas. Carbon monoxide intoxication is claimed to be the most common cause of poisoning in the United States, accounting for thousands of deaths per year and with a high incidence of persistent or delayed neurologic sequelae.22, 70 The most common cause of carbon monoxide intoxication in the United States is unintentional exposure to motor vehicle exhaust. Attempted carbon monoxide intoxication is a common means of attempting suicide. Other potential

3-NITROPROPRIONIC ACID

In the early 1970s, a new syndrome of acute noninflammatory encephalopathy was noted among children in northern provinces of the People's Republic of China. Clinical and epidemiologic studies established that this syndrome followed consumption of mildewed sugarcane. Over the course of the 1970s and 1980s, there were over 200 documented outbreaks involving hundreds of victims and with numerous deaths. The offending agent was established to be the mycotoxin 3-nitropriopionic acid (3NP), a product

1-METHYL-4-PHENYL-1, 2, 3, 6-TETRAHYDROPYRIDINE

The discovery of 1-methyl-4-phenyl-1, 2, 3, 6-tetrahydropyridine (MPTP) as a dopamine neuron neurotoxin is a remarkable story. In the early 1980s, so-called designer drugs, mainly opiate analogs, were produced by individuals eager to take advantage of a loophole in Federal laws governing the manufacture and sale of scheduled drugs. One chemist in the northern California area attempted to produce the meperdine analog 1-methyl-4-phenyl-4-proprionoxypiperidine (MPPP). An apparently sloppy worker,

ANNONACEAE ALKALOIDS

A recent report by Caparros-Lefebvre et al13 documented an unusually high incidence of atypical parkinsonism on the Caribbean island of Guadeloupe.13 Efforts were made to ascertain cases systematically, although there is only a single department of neurology on the island. Seventy-five percent (65 of 87) of cases of parkinsonism seen over a 2-year period were classified as atypical. A majority met NINDS consensus criteria for progressive supranuclear palsy (PSP; 36% of total) or atypical

SUMMARY

A number of exogenous toxins cause basal ganglia degeneration. Most of these toxins result in putaminal and/or pallidal pathology although MPTP causes remarkably specific degeneration of nigrostriatal dopaminergic neurons. In virtually all cases, the established or likely mechanism of neurodegeneration is impairment of neuronal energy metabolism, usually at the level of mitochondria. For reasons that are unclear, neurons of the globus pallidus and putamen appear to be particularly susceptible

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    Address reprint requests to Roger L. Albin, MD, Neuroscience Laboratory Building, 1103 E. Huron, Ann Arbor, MI, 48104-1687

    This work is supported by grants from National Institutes of Health, NS 15655, NS 38166, and a VA Merit Grant.

    *

    Department of Neurology, University of Michigan; and the Neuroscience Research, Geriatrics Research, Education and Clinical Center, Ann Arbor VAMC, Ann Arbor, Michigan

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