Lead Encephalopathy with Distinctive Brain Magnetic Resonance Imaging Findings

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.