Dr. Pulley of the University of Florida, Jacksonville, received honorariums from Argenx, Bio Products Laboratories, Catalyst, CSL Behring, and Stealth BioTherapeutics for consulting work.)
Dr. Weimer of Columbia University has received consulting fees from Roche.)
This article includes discussion of hexacarbon neuropathy and hydrocarbon neuropathy. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.
The author reviews the clinical features of an interesting toxic neuropathy. This neuropathy was fairly common in the past, related to recreational glue sniffing, but is primarily occupational currently. The axonal swellings seen in hexacarbon neuropathy are similar to those seen in carbon disulfide and acrylamide neuropathy.
• Hexacarbons are present in many solvents and glues, and exposure is most commonly occupational.
• The neuropathy associated with hexacarbon exposure results in giant axonal swellings and distal slowing of conduction velocity.
• Hexacarbon neuropathy may continue to worsen for some time after cessation of exposure (coasting).
Historical note and terminology
Hexacarbons are used as solvents and are components of lacquers and glues. Exposure to the hexacarbons occurs in petroleum production and refining industries. Glues and lacquers are widely used in the shoe and cabinet-making industries (Herskowitz et al 1971; Cianchetti et al 1976). Initial reports of occupational exposure to hexacarbons centered on the sandal- and shoe-making industries of Japan (Iida et al 1969; Yamamura 1969). Subsequent similar outbreaks of hexacarbon neuropathy were reported in Italy and in cabinet-finishing plants in the United States (Herskowitz et al 1971). Substitution of methyl n-butyl ketone for methyl ethyl ketone and methyl isobutyl ketone in the manufacturing of plastic-coated and color-coated fabrics prompted an epidemic of peripheral neuropathy in 1974 and 1975 (Mendell et al 1974). Other reports have pointed out the risk of n-hexane neuropathy among automotive technicians using degreasing and cleaner solvents (Centers for Disease Control and Prevention 2001), screen printers in India (Puri et al 2007; Puri et al 2015; Pradhan and Tandon 2015), and in the pharmaceutical industry in China (Pan et al 2017). Intentional inhalation (glue sniffing) is also a cause of high-level exposure (Gonzalez and Downey 1972; Chaqda et al 2019). Hexacarbon-related neuropathy is less common at present because of the removal of hexacarbons from many industrial and commercial products. However, recreational abuse, usually by means of glue sniffing, remains a substantial epidemiologic problem. Occupational exposures are still the most common cause in less developed countries (Misirli et al 2008; Sendur et al 2009).
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