By Michael R. Dobbs
Medical Neurotoxicology bargains exact, suitable, and finished insurance of a box that has grown enormously within the final two decades. you will get a present symptomatic method of treating problems brought on by neurotoxic brokers, environmental factors-such as heavy metals and pesticides-and extra. observe discussions of mobile and molecular strategies and pathology to scientific neurology. prime professionals and up-and-coming medical neurotoxicologists current their services on wide-ranging, international topics and debate controversies within the uniqueness, together with Gulf warfare Syndrome. And, professional seek advice performance enables you to entry the whole textual content of the ebook on-line, from any net connection.Provides a whole directory of neurotoxic agents-from synthetic to environmental-so you get entire, medical coverage.Covers how pollutants take place themselves in response to age and co-morbidity that you can deal with the wishes of all of your patients.Offers vast and in-depth assurance of poisons from worldwide via contributions by way of best specialists and up-and-coming scientific neurotoxicologists.Features dialogue of debatable and weird themes reminiscent of Gulf battle Syndrome, Parkinson's ailment, motor neuron illness, in addition to different concerns which are nonetheless in question.Includes entry to www.expertconsult.com, a spouse site the place you could quick seek the entire contents of the book.Your buy entitles you to entry the website until eventually the subsequent version is released, or until eventually the present variation isn't any longer provided on the market through Elsevier, whichever happens first. If the subsequent variation is released below twelve months after your buy, you may be entitled to on-line entry for three hundred and sixty five days out of your date of buy. Elsevier reserves the best to provide an appropriate alternative product (such as a downloadable or CD-ROM-based digital model) may still on-line entry to the website be discontinued.
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However, most of these, including the serotonin-speciﬁc reuptake inhibitors, rarely cause seizures. Several agents are well known to promote seizure activity, such as cyclic antidepressants, venlafaxine, and bupropion. TCAs deserve special discussion due to their complex pharmacologic and toxicological mechanisms. Seizures secondary to TCAs are directly caused by GABA antagonism, as well as antihistamine effects. TCAs have other toxic effects, which include antimuscarinic effects leading to profound anticholinergic symptoms.
A comatose patient who smells of alcohol may be harboring an intracranial hemorrhage, while an agitated patient who appears anticholinergic may actually be encephalopathic from an infectious etiology. Patients must be thoroughly assessed and appropriately stabilized. It is vital not to miss easily treatable conditions. 1,2 Patients with altered mental status should receive rapid determination and, if necessary, correction of serum glucose levels. There is often no speciﬁc antidote or treatment for a poisoned patient, and careful supportive care may be the most important intervention.
Some toxins may show focal neurological deﬁcits superimposed on a Section 1 • Neurotoxic Overview Table 4: The Neurological Examination and Representative Toxins by System System and Testing Representative Toxins MENTAL STATUS Radiation, chemotherapies, toluene, methanol, ethanol, lead, mercury LANGUAGE CRANIAL NERVES I (Olfactory) II (Optic) Pupils afferent Color vision Acuity Visual ﬁelds Funduscopy Mercury, toluene, methanol, styrene, vigabatrin III (Oculomotor) Pupils efferent Botulinum toxin, organophosphates, opiates III (Oculomotor), IV (Trochlear), and VI (Abducens) Eye movements Botulinum toxin, tetrodotoxin, tick toxin, some arachnid and reptile venoms V (Trigeminal) Sensory face and scalp (V1–V3) Trichloroethylene MOTOR MUSCLES OF MASTICATION VII (Facial) Motor facial expression Salivation and lacrimation Taste anterior 1⁄3 of tongue Corneal reﬂex efferent Thallium, arsenic, botulinum toxin, buckthorn berry, barotrauma (environmental) VIII (Vestibulocochlear) Vestibular testing Hearing Lead, carbon monoxide, aspirin, quinine, macrolides IX (Glossopharyngeal) and X (Vagus) Gag, palatal elevation Tetanus and botulinum toxins; vomiting induced by many agents via cranial nerve X XI (Accessory) Trapezius and sternocleidomastoid power XII (Hypoglossal) Motor-intrinsic tongue muscles Tetanus and botulinum toxins Continued 23 Chapter 3 • Approach to the Outpatient with Suspected Neurotoxic Exposure Table 4: The Neurological Examination and Representative Toxins by System—cont’d System and Testing Representative Toxins MOTOR Drift Bulk and tone Muscular power Fisher’s test Lead (focal), thallium, organophosphates, buckthorn berry, lathyrus, botulinum toxin, tetrodotoxin, tick toxin, some arachnid and reptile venoms, tetanus toxin REFLEXES Deep tendon reﬂexes Abdominal reﬂexes Plantar responses Hoffmann’s responses Other sacral reﬂexes Lathyrus, barbiturates, physostigmine, buckthorn berry, tetanus toxin COORDINATION Finger-to-nose and heel-to-shin testing Rapid alternating movements Ethylene glycol, ethanol, phenytoin, methylmercury SENSORY Pinprick Light touch Vibration Proprioception Graphesthesia Ethanol, arsenic, nitrous oxide GAIT AND STATION Standing at rest Stand in tandem Walking normally Walking on heels, toes, and heel to toe Manganese, ethanol, ethylene glycol, phenytoin FRONTAL RELEASE SIGNS Glabellar Rooting Snout Palmomental Grasp Carbon monoxide TREMOR AND OTHER ABNORMAL MOVEMENTS Carbon monoxide, manganese, mercury, caffeine, cocaine AUTONOMIC 24 Orthostatic testing Perspiration level Salivation/lacrimation Organophosphates, muscarine (mushrooms), tetanus toxin MALINGERING AND CONVERSION TESTING Pseudotoxicity Section 1 generalized encephalopathy.