Objective: Delineation of clinical and radiological features of cerebellar ataxia from volatile solvent abuse.

Background: Volatile solvents like glues, correction fluid, acrylic paints, varnishes, lacquers and paint thinners containing toluene are often abused by young adults because of their low cost and easy availability [1]. Because of the lipophilic property, repeated exposure leads to accumulation of toluene in lipid-rich organs like brain, damaging myelin and neuronal membranes [2,3].

Method: Patients with cerebellar ataxia, attending the Movement disorder clinic at Institute of Neurosciences Kolkata (I-NK) from 1^st Jan 2022 to 31st Dec 2023, were screened and stratified as per possible etiology. Among them, we selected 3 patients with ataxia resulting from volatile solvent abuse.

Results: Case 1: 16/M, presented with progressive gait imbalance for 8 months with mild cognitive decline and behavioural change for 2 months. Gaze-evoked nystagmus noted along with asymmetric postural and action tremor, dysmetria, spasticity and ataxic gait [Figure 1A]. MRI brain revealed T2 hyperintensities in white matter, in PLIC with thalamic hypointensity. Several bottles of eraser fluid containing toluene were discovered from the patient’s room [Figure 2A].

Case 2: 17/F, presented with tremulousness for 2 years with gait imbalance for 1 year. Ataxic dysarthria, coarse postural and action tremor and dysmetria noted along with spasticity, brisk reflexes and gait ataxia [Figure 1B]. MRI showed cerebellar atrophy, T2 hyperintensity in brainstem and PLIC with pallidal and thalamic hypointensity [Figure 2B]. She was sniffing scented glue sticks containing toluene.

Case 3: 25/M, presented with bilateral upper limb tremor for 4 years and gait imbalance for 2 years. He has developed a change in personality with hypersexuality along with cognitive decline for 2 years. Asymmetric postural and action tremor were noted along with dysarthria, dysmetria, ataxic gait and brisk reflexes [Figure 1C]. MRI showed brainstem and PLIC hyperintensity with pallidal hypointensity [Figure 2C]. He was addicted to glues containing toluene, being used in his father’s factory.

SCA panel and whole exome sequencing were normal in all 3 of them.

Conclusion: Exposure to volatile solvent abuse should be specifically asked for in young adults with cerebellar ataxia and tremor. Radiologically, hyperintensities in PLIC along with thalamic and pallidal hypointensity is a clue for suspecting this etiology.

Gait ataxia and dysmetria

MRI Brain

References: [1] Kurtzman TL, Otsuka KN, Wahl RA. Inhalant abuse by adolescents. J Adolesc Health. 2001 Mar;28(3):170-80. doi: 10.1016/s1054-139x(00)00159-2.

[2] Filley CM, Halliday W, Kleinschmidt-DeMasters BK. The effects of toluene on the central nervous system. J Neuropathol Exp Neurol. 2004 Jan;63(1):1-12. doi: 10.1093/jnen/63.1.1.

[3] Fearon C, Rawal S, Olszewska D, et al. Neuroimaging Pearls from the MDS Congress Video Challenge. Part 2: Acquired Disorders. Mov Disord Clin Pract. 2022 Feb 3;9(3):311-325. doi: 10.1002/mdc3.13415.

« Back to 2024 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/volatile-solvent-abuse-and-cerebellar-ataxia-a-case-series/