Hereditary neuropathy with predisposition to pressure palsy
Nov. 09, 2023
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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).
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 (12; 08). Initial reports of occupational exposure to hexacarbons centered on the sandal- and shoe-making industries of Japan (15; 38). Subsequent similar outbreaks of hexacarbon neuropathy were reported in Italy and in cabinet-finishing plants in the United States (12). 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 (22). Other reports have pointed out the risk of n-hexane neuropathy among automotive technicians using degreasing and cleaner solvents (06), screen printers in India (29; 30; 28), and in the pharmaceutical industry in China (26). Intentional inhalation (glue sniffing) is also a cause of high-level exposure (11; 07). 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 (23; 32).
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