All of the following can cause neuropathies with predominant motor involvement except:
Correct Answer: Arsenic intoxication
Description: Ref: Harrison’s 18/e p3463
Arsenic is another heavy metal that can cause a toxic sensorimotor polyneuropathy. The neuropathy manifests 5–10 days after ingestion of arsenic and progresses for several weeks, sometimes mimicking GBS.
The presenting symptoms are typically an abrupt onset of abdominal discomfort, nausea, vomiting, pain, and diarrhea followed within several days by burning pain in the feet and hands.
Examination of the skin shows increased or decreased pigmentation on the skin several weeks after an acute exposure or with chronic low levels of ingestion. Mee's lines, which are transverse lines at the base of the fingernails and toenails, do not become evident until 1 or 2 months after the exposure. Multiple Mee's lines may be seen in patients with long fingernails who have had chronic exposure to arsenic. Mee's lines are not specific for arsenic toxicity as they can also be seen following thallium poisoning.Because arsenic is cleared from blood rapidly, the serum concentration of arsenic is not diagnostically helpful. However, arsenic levels are increased in the urine, hair, and fingernails of patients exposed to arsenic. Anemia with stippling of erythrocytes is common, and occasionally pancytopenia and aplastic anemia can develop.
Increased CSF protein levels without pleocytosis can be seen; this can lead to misdiagnosis as GBS. NCS are usually suggestive of an axonal sensorimotor polyneuropathy; however, demyelinating features can be present.
Chelation therapy with BAL has yielded inconsistent results; therefore, it is not generally recommended.
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