Abstract
BackgroundEncephalopathy is an uncommon but serious presentation of lead toxicity.ObjectiveWe aimed to determine and follow-up the brain magnetic resonance imaging (MRI) abnormalities in the patients with lead encephalopathy due to ingestion of lead contaminated opium.MethodsIn a cross-sectional study during lead-contaminated opium outbreak, all lead-poisoned patients with any signs/symptoms of encephalopathy were included.ResultsOf 19 patients with lead encephalopathy, five died early and other five could not be sent to MRI during their hospitalization period. Mean age was 51 ± 11 years and males were dominant (89%). Median [IQR] blood lead level (BLL) was 101 [81, 108] μg/dL (range; 50 to 200 μg/dL). There was no correlation between MRI findings and signs/symptoms. MRI was normal in six and abnormal in three. Bilateral symmetric involvement of parieto-occipital lobes was observed. Gray matter, gray-white matter junction, and subcortical white matter were also affected. Follow-up MRI was performed in two with abnormal MRI which showed complete and near complete resolution of the abnormalities after cessation of opium use and treatment. Conclusion: There was no correlation between MRI findings and BLL. Complete recovery of brain MRI lesions was detected after cessation of opium use.
Highlights
Encephalopathy is an uncommon but serious presentation of lead toxicity
Lead encephalopathy is generally described by sudden commence of the manifestations including severe headache, vomiting, convulsions, mental aberration and excitement [2]
Selection of participants All lead-poisoned patients who referred with any signs/ symptoms of encephalopathy including loss of consciousness or seizure were considered as the potential participants through a chart review of the admitted patients during outbreak [3]
Summary
Encephalopathy is an uncommon but serious presentation of lead toxicity [1]. Lead encephalopathy is generally described by sudden commence of the manifestations including severe headache, vomiting, convulsions, mental aberration and excitement [2]. Blood lead levels (BLLs) of higher than 100 μg/dL generally accompany with lead encephalopathy, much lower levels (as low as 38 μg/dL) may result in encephalopathy in chronic toxicities [1]. Lead-contaminated opium has been recently discussed in the literature [6]. The objective of the current report was to determine the magnetic resonance imaging (MRI) characteristics of lead encephalopathy due to ingestion of lead-contaminated opium. We aimed to perform a follow-up MRI after treatment in these patients to see if treatment improved their MRI abnormalities
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