Disturbed oxidative metabolism in organic brain syndrome caused by bismuth in skin creams

Two patients are described with an organic brain syndrome thought to be due to bismuth (Bi) absorbed from a skin cream. Both patients had intellectual impairment and memory loss punctuated by periods of confusion, tremulousness, clumsiness, difficulty in walking, and myoclonic jerks. A similar clinical picture has been reported from Australia and France in patients taking insoluble bismuth salts by mouth. Bi was found in cerebral venous blood in both patients and in the cerebrospinal fluid in one. It is suggested that bismuth can cross the blood/brain barrier and disturb oxidative cerebral metabolism, because increased lactate production was found with decreased consumption of oxygen and glucose and lowered cerebral blood-flow.