Arsenic neuropathy

Introduction
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By Michael T Pulley MD PhD and Alan R Berger MD

Arsenic toxicity has predominately been the result of suicidal or homicidal ingestion of massive quantities of arsenic. However, in India and Taiwan, presence of arsenic in drinking water has made the problem endemic. In this review, Dr. Michael Pulley, Director of The EMG Laboratory and Assistant Professor of Neurology, University of Florida Jacksonville, and Dr. Alan Berger, Professor and Chairman of Neurology, University of Florida Jacksonville, discuss the clinical manifestations, diagnosis, and management of acute and chronic arsenic poisoning. The focus of the summary is on the effects of arsenic on the peripheral nervous system.

Key Points

  • Although arsenic is known more for intentional poisonings in homicides or suicides, arsenic toxicity is more common with occupational exposure or through drinking water in endemic areas.
  • As with other heavy metal intoxications, the neuropathy related to arsenic is rarely seen without other systemic manifestations, including abdominal pain and skin changes.
  • Arsenic neuropathy causes painful paresthesias and, with higher level or continued exposure, length-dependent weakness.

In This Article

Introduction
Historical note and nomenclature
Clinical manifestations
Etiology
Pathogenesis and pathophysiology
Epidemiology
Prevention
Differential diagnosis
Diagnostic workup
Prognosis and complications
Management
References cited
Contributors