Objective: To report a case of a young patient with opsoclonus, ataxia and peripheral neuropathy due to toluene intoxication.  

Background: Amid the causes of secondary ataxias, the most common are due to infection, auto-immune diseases and intoxications. Opsoclonus can be a result of CNS infections, paraneoplastic syndrome, auto-immune diseases or intoxications. Thinner is a common recreational drug in Brazil; one of its main components is toluene hydrocarbonate, which can cause a number of neurological syndromes.

Methods: Case Report

Results: A 37 y/o male patient who worked as a gardener presented to the outpatient clinic complaining of a trembling vision that had begun roughly one year before, as well as dizziness and difficulty to walk unaided that developed over the last two months, becoming bed-ridden. He had been inhaling thinner, a toluene-rich chemical on a daily-basis over the last 20 years. Neurological examination disclosed opsoclonus, dismetric movements of the upper limbs, ataxic gait, loss of tactile and pain sensations and absent deep tendon reflexes in the lower limbs. A thorough work-up ruled-out the possibility of underlying malignancy. Serological testing for infectious diseases was negative and serum levels of B1 and B12 vitamins were normal. CSF analysis was normal. Brain MRI disclosed abnormal signal abnormalities on FLAIR compromising the white matter of both temporo-parietal lobes, as well as the midbrain. CT scans of cervical, thoracic and lumbar spine ruled-out compressive myelopathy. An abnormal ENMG study was compatible with chronic sensorial neuropathy with predominantly distal axonal compromise on both lower limbs.  He was treated with a pulse of 1 g/day of Methylprednisolone over five days with marked improvement of ataxia and was discharged with oral Prednisone 40 mg qd.     

Conclusions: Although opsoclonus often suggests the possibility of underlying malignancy or CNS infection, toxic and metabolic causes should also be considered in the differential diagnosis.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/ataxia-opsoclonus-and-peripheral-neuropathy-induced-by-chronic-toluene-intoxication/