Lead Encephalopathy with Distinctive Brain Magnetic Resonance Imaging Findings

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Ameya Patwardhan1, Nalini Atchayaram1, Jitender Saini2

  • 1Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India.

Neurology India
|November 8, 2021
PubMed

Insights

Lead poisoning can cause severe neurological symptoms like encephalopathy in adults. Early diagnosis through clinical and imaging clues is crucial for prompt treatment and preventing further lead exposure.

Area of Science:

  • Neurology
  • Toxicology
  • Occupational Health

Background:

  • Lead poisoning is a multisystem disorder, often affecting children, but adults can develop lead encephalopathy from occupational exposure, traditional medicines, or contaminated alcohol.
  • Adult lead toxicity can manifest with diverse symptoms, including neurological deficits, gastrointestinal issues, and hematological abnormalities.

Observation:

  • A 50-year-old battery mechanic presented with acute encephalopathy, symptomatic hyponatremia, and chronic abdominal colic and vomiting.
  • Clinical examination revealed anemia, basophilic stippling, a lead line on the gums, and chronic hypertension, with a blood lead level exceeding 65 mcg/dL.

Findings:

  • Brain imaging showed intracranial calcifications on CT and bilateral symmetric involvement of the thalamus, basal ganglia, brainstem, and external capsule on MRI.
  • While sensorium improved rapidly after hyponatremia correction, apathy and psychomotor slowing persisted, indicating residual neurological impact.

Implications:

  • This case underscores the importance of recognizing subtle clinical markers and characteristic neuroimaging findings for early diagnosis of lead toxicity.
  • Prompt chelation therapy and avoidance of further lead exposure are vital to manage lead encephalopathy and mitigate long-term neurological sequelae.

Keywords:
Intracranial calcificationshyponatremialead encephalopathylead line

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