PETROL SNIFFERS ENCEPHALOPATHY - A STUDY OF 25 PATIENTS

Objectives: To determine the clinical features, response to treatment and outcome of petrol sniffers presenting to Perth's teaching hospital s. Design: Retrospective study of all admissions to Perth's tertiary r eferral hospitals that were related to petrol sniffing from 1 January 1984 to 31 December 1991. Results: Twenty-five patients (22 male and 3 female) were admitted with a diagnosis of intentional petrol sniffing . Five presented with acute petrol intoxication as the result of an is olated action. The remaining 20 patients were ''chronic petrol sniffer s''. The mean age was 17.7 years (range, 5-27 years). Twenty patients were Australian Aborigines, including 18 of 20 chronic petrol sniffers and the three females. In the chronic petrol sniffers, a high prevale nce of seizures and an alarmingly high case fatality ratio (8 of 20), usually by sudden death, were found. An altered mental state was unive rsal, manifesting as drowsiness, delirium or stupor. Generalised tonic -clonic seizures occurred in 14, three with status epilepticus. Myoclo nus (9), chorea (8) and cerebellar ataxia (appendicular and truncal) ( 13) were common. High blood lead levels on presentation were associate d with a poor prognosis (survivors v. deaths, P=0.002). Eighteen of th e 20 patients were treated with specific agents to reduce the lead loa d, but the results were extremely disappointing. Conclusion: Petrol sn iffing is an important cause of sickness and death in young people fro m some rural Aboriginal communities. It can cause sudden death or irre versible encephalopathy. Those severely affected have a poor prognosis , despite treatment. Effective strategies for prevention are needed.