Multifocal brain damage due to lacquer sniffing: the first case report of Thailand

The first patient of multifocal brain damage due to lacquer sniffing was reported in Thailand. He was a 24-year-old man who had a 5 year history of lacquer sniffing (toluene abuse). He had difficulty in walking and had tremor for 1 year which became progressively worse and he was finally confined to bed. Examination revealed marked cerebellar signs of both upper and lower extremities with scanning speech. Five of his friends who were lacquer abusers also had similar symptoms and were confined to bed. Investigations showed marked atrophy of both cerebellar hemispheres, vermis, brainstem and less atrophy of both cerebral hemispheres in both computerized brain scanning and magnetic resonance imaging. Diffuse toxic demyelination of white matter and excess iron deposition over both thalami, basal ganglia and cerebral cortex were demonstrated on magnetic resonance imaging. Brainstem evoked response showed abnormal response of both sides. Nerve conduction velocity, electromyographic study and electroencephalogram were normal. Psychometric tests revealed dull normal or below average IQ-test of 82. He was admitted for 2 months with gradual recovery of neurological deficits. After six months of abstinence from lacquer and daily physical rehabilitation. This report of toluene abuse is not only public health problem but also reflects the socioeconomic status as well as political unawareness of this condition in the Thai community.