A 47 y.o. biochemist is found in his lab confused and urinating on the floor.
What is wrong with the patient?
This patient had a central neurocytoma; a benign intraventricular tumor arising from glial cells in the septum pellucidum. The treatment of the tumor is surgical with 20% recurring. Those that recur tend to be MIB-1 positive (labeling index) and spread through the CSF.
The tumor was first described in 1982 by Hassoun and usually presents with signs of hydrocephalus. Patients present with headache, memory loss or gait disturbance. In talking to the PI of the lab where our patient worked the patient had been having difficulty completing his experiments for four months. The PI attributed this to anxiety.
Our patient underwent surgical resection without complications.
Teaching point:
In evaluating someone working in a lab setting, consider solvent exposure as a source of altered mental status. We commonly see toluene causing altered mental status in “huffers” but workplace solvents are also known to cause CSE, chronic solvent encephalopathy. This was first documented in 1960 in Finland when a series of cases were presented by Helena Hanninen in workers exposed to carbon disulfide in a rubber manufacturing plant.
https://en.wikipedia.org/wiki/Gloria_Ramirez as the case appeared on TV.
And of course, there is the controversial case of 23 of 37 ED staff being exposed to DMSOon a patient who used it for muscle aches. It was converted with O2 to dimethyl sulfone and then presumably to dimethyl sulfate which is a toxic gas. In that case, 5 were hospitalized ; one for two weeks with pancreatitis.
BEWARE THE SOLVENTS but look for horses before zebras with brain tumors being more common than toxic exposures at least in the WU labs.
Kerkeni A, BenLakhdher Z, Rkhami M. 2010 Central neurocytoma study of 32 cases and review of the literature. Neurochirurgie 56(5) 408-14.
Hassoun J, Gamparelli D, et al. Entral neurocytoma an electron microscopic study of 2 cases. ACTA Neuropathol 56(2):151-6.
Kim JW, Kim DG. Et al. Radiosurgery for central neurocytoma long term outsome and failure pattern 2013. J Neurooncol. 115:505-11.
Krstev Srmena et al. Neuropsychiatric effects in workers with occupational exposure to carbon disulfide. Journal of Occ Health 45:81-87.