Lead encephalopathy in adults

Abstract

In a study of twenty-three adults with lead encephalopathy observed at the University of Alabama Medical Center, and in a review of the data on thirty-one similar patients described in the literature over the past decade, we found the following: In most of the patients the source of lead was moonshine; most had anemia with erythrocyte basophilic stippling. The severity of symptoms ranged from confusion and disorientation to repeated seizures, coma and death. Lateralizing neurologic signs were observed in 35 per cent of our patients. Pleocytosis of the cerebrospinal fluid, when present, was almost invariably low grade (ranging from 5 to 27 white blood cells/cu mm), and the cerebrospinal fluid protein level was elevated (ranging from 50 to 185 mg per cent) in 63 per cent of our patients. We used the following criteria to aid in diagnosis: (1) demonstration of a diffuse encephalopathy; (2) diagnosis of lead toxicity; (3) observation of definite clinical diminution of the encephalopathy with calcium versenate therapy; and (4) exclusion of other causes of encephalopathy. Even when all these criteria are fulfilled, the diagnosis in an individual patient may be extremely difficult to make, especially when the source of lead is moonshine and all the complications of alcoholism are present.