What is the role of mercury in the etiology of toxic neuropathy?

Updated: Dec 06, 2017
  • Author: Jonathan S Rutchik, MD, MPH, FACOEM; Chief Editor: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS  more...
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Answer

Inorganic mercury is used in the chloralkali industry. Other uses are noted in Table 3. Neuropathy and PNS dysfunction, often motor more than sensory, were noted in the cases summarized here.

Albers et al reported 138 chloralkali plant workers with long-term exposure to inorganic mercury vapor who were found to have elevated urine mercury levels and reduced sensation on quantitative testing. Subjects exposed to mercury for 20-35 years who had urine mercury levels greater than 0.6 mg/L demonstrated significantly less strength, poorer coordination, more severe tremor, more impaired sensation, and higher prevalence of Babinski and snout reflexes than controls. Subjects with polyneuropathy had higher peak levels of mercury than healthy subjects. [11]

In another study by Andersen et al, chloralkali workers exposed to inorganic mercury vapor for an average of 12.3 years revealed a higher prevalence of reduced distal sensation, postural tremor, and impaired coordination than controls. [26] Barber reported 2 employees of a chloralkali plant who had findings suggestive of amyotrophic lateral sclerosis (ALS). Signs, symptoms, and laboratory findings returned to normal 3 months after withdrawal from exposure. [27] Adams et al reported a 54-year-old man with a brief but intense exposure to mercury vapor, which led to a syndrome resembling ALS that resolved as urinary mercury levels fell. [28] Ross reported that prolonged application of an ammoniated ointment to the skin was a cause of motor polyneuropathy, with cerebrospinal fluid (CSF) findings suggestive of Guillain-Barré syndrome. [29]

Warkany and Hubbard reported the association of acrodynia and symmetrical flaccid paralysis with mercury toxicity. [30]

Organic mercury was deemed the culprit in a number of historic environmental accidents. One noted catastrophe, reported by Yoshida et al, occurred in Minimata Bay, Japan, and involved organic mercury. The majority of Minimata patients with methylmercury intoxication had elevated pain thresholds but suffered from glove and stocking hyperesthesia in the extremities. [31]


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