Severe neuropathy due to inhalant abuse in adolescents from Pretoria

Figures & data

Table 1: Clinical findings

	Patient 1	Patient 2	Patient 3	Patient 4
Higher function	Normal	Normal	Normal	Normal
Cranial nerves I–XII	All intact, except facial weakness	All intact, except facial weakness	Normal	Normal
Power
-Neck flexion	4/5	4/5	5/5	4+/5
-Upper limb	Shoulder and elbow abduction and adduction 3/5 Wrist and fingers 1/5	Shoulder and elbow abduction and adduction 4/5 Wrist and fingers 3/5	Shoulder and elbow abduction and adduction 5/5 Wrist and fingers 4-/5	Shoulder and elbow abduction and adduction 4-/5 Wrist and fingers 4-/5
-Lower limb	Hip and knee flexion and extension 2–3/5 Foot dorsi- and plantar flexion, toes 0/5	Hip and knee flexion and extension 4-/5 Foot dorsi- and plantar flexion, toes 1/5	Hip and knee flexion and extension 5/5 Foot dorsi- and plantar flexion, toes 4-/5	Hip and knee flexion and extension 3/5 Foot dorsi- and plantar flexion, toes 1/5
Tone all limbs	Normal/low	Normal	Normal	Normal/low
Deep tendon reflexes	Areflexia	1+ upper limbs Absent lower limbs	Areflexia	Areflexia
Plantar response	Down going	Down going	Down going	Down going
Sensory
-Spinothalamic	Glove and stocking hyperpathia	Glove and stocking sensory loss	Glove and stocking reduced sensation	Glove and stocking sensory loss
-Dorsal columns	Reduced in toes	Normal	Normal	Normal

Figure 1: Magnetic resonance image of the brain of Patient 4

Note: The MRI showed mild frontal atrophy.

Figure 2: EEG of Patient 4

Note: The EEG showed diffuse moderate slowing indicating a generalised cerebral dysfunction.

Figure 3: Nerve conduction study of the tibial nerve

Note: This showed marked dispersion and a decrease in amplitude.