Trimethyltin encephalopathy
R. G. Feldman, R. F. White and I. I. Eriator
Department of Neurology, University Hospital, Boston.
A chemistry student was acutely exposed to vapors of an organotin compound.
Seventy-two hours later, he exhibited delirium, spatial disorientation,
perseveration, inappropriate affect, and memory defects. Five months later,
he experienced episodes of complex partial seizures, which continue to
require anticonvulsant medication after 7 years. Trimethyltin was
identified in blood and urine samples taken 17 days after the accident; the
blood level of trimethyltin was elevated 35 days after exposure. Serial
electroencephalograms showed persistent left temporal paroxysmal
epileptogenic potentials. Serial neuropsychological tests revealed
persistent memory defects, cognitive dysfunction, and dysphoria 4 years
after exposure. We review acute, resolving, and long-term residual
neurotoxic effects of trimethyltin in man. We describe detailed clinical
observations, serial neuropsychological test results,
electroencephalographic findings, and exposure data in this patient,
confirming the limbic system effects of trimethyltin and relating them to
the known histopathologic pattern of this condition.
