MULTIPLE SYSTEM ATROPHY FOLLOWING CHRONIC CARBON-DISULFIDE EXPOSURE

Carbon disulfide toxicity is well characterized. The principal target organ is the nervous system, although cardiovascular, reproductive, op hthalmologic, and other effects are also recognized. The neurotoxicity manifests in three ways: encephalopathy, peripheral and cranial nerve dysfunction, and movement abnormalities. This report describes a case of olivopontocerebellar atrophy, a form of multiple system atrophy, d eveloping in an adult after over 30 years of occupational exposure to carbon disulfide. The patient presented with the insidious onset of ba lance problems, impotence, and irritability, without tremor, cogwheel rigidity, bradykinesia, or changes in facial expression. Over the next few years severe ataxia developed, and the clinical diagnosis was con firmed with computed tomography and magnetic resonance imaging scans. The patient experienced multiple medical complications and died approx imately 9 years after diagnosis. This case is consistent with a large body of clinical and experimental literature, much of it 50 years old, showing that carbon disulfide can cause movement disorders. It also s erves as a reminder that movement disorders, ranging from parkinsonism to dystonia, are associated,vith a variety of toxic exposures such as manganese, carbon monoxide, 1-methyl-4-phenyl-1,2,3,6-tetrahydropyrid ine and medications.