Neurological deficits in solvent-exposed painters: a syndrome including impaired colour vision, cognitive defects, tremor and loss of vibration sensation

Five individuals are described who had participated in a study of former do ckyard painters. All had worked between 16 years and 45 years as industrial painters, much of the time inside ships. All underwent structured neurolog ical examination, colour vision testing (allowing calculation of a colour c onfusion index corrected for age and alcohol), and detailed psychometric te sting. An occupational history sufficient to allow estimation of past expos ure to solvents was taken. All gave a history of exposure to high concentra tions of solvents at work, and several described episodes of acute narcosis . All showed neurological deficits and some had overt neurological disease, although in no case had this previously been linked to their work. The mos t striking features, sufficient to constitute a syndrome, were acquired blu e-yellow colour vision deficits, coarse tremor, impaired vibration sensatio n in the legs and cognitive impairment. Their estimated cumulative exposure s to solvents ranged between the equivalent of 13 and 37 calendar years wor king at the Occupational Exposure Standard concentration (OES years). This study for the first time gives an indication of the concentrations of solve nts likely to lead to serious neurological disease in humans. It serves as a reminder to physicians to take an occupational history from patients with obscure neurological or psychological impairment.