Science Letters

Reversible Toluene-Induced Leukoencephalopathy in a Worker with Long Term Exposure: A Case Report and Literature Review

Abdul Azeez Alsharif 1, Ahsan Ali Khan 2, Xiu Xiu Tian 1, Jia Min Wang 1, Furqan Nasir 3, Yi Jing Guo 1*

1 Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, PR China

2 Department of Neurosurgery, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, PR China

3 Department of Pediatrics and Neonatal Intensive Care Unit, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, PR China

Abstract

Chronic psycho-organic syndrome was first reported in 1976 in long-term house painters. Toluene-induced leukoencephalopathy's manifestations range from inattention, memory dysfunction, neurobehavioral impairment, coma and even death. A 33-year old male automotive painter was brought to the clinic with memory decline, dizziness, and dull response occurring gradually over a period of time, but became more apparent one week ago when patient lost his way in a familiar environment while he was driving his car. Neuroimaging reveal white matter injury. The patient was admitted for one month and was started on coenzyme Q10 250 ml and coenzyme Q10 complex 100 IU in 100 ml 0.9% NaCl. He was also prescribed a six-month course of vitamin C 0.1 g, vitamin B complex 0.1 g, vitamin E 0.1 g, and coenzyme Q10 tablets (Ubiquinone) 10 mg. The patient had significant improvement clinically and radiologically after receiving the proper medical treatment. Abstinence from toluene may slow the process of white matter alteration and prevents further neuropsychological deterioration in patients with toluene-induced leukoencephalopathy, but it may be more helpful if management includes neuroprotective agents and antioxidants. The co-administration of coenzyme Q10, vitamin B, C and E may be an effective treatment of toluene leukoencephalopathy. To our knowledge, this is the first report that describes reversible leukoencephalopathy caused by prolonged exposure.