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laid down by various work groups can act as optimizer. information or molecular imaging techniques such as
Dr. Jamal also mentions about an integral approach the MR diffusion –weighted imaging or MR
consisting of relevant disciplines. This, I believe ought spectroscopy. MR imaging with diffusion and
to be a product of team work and the job to be done in perfusion imaging provides information regarding
phases. The first person to start the ball to roll is the brain lesions induced by the toxic agents (vasogenic
surgeon and then with collaboration of the edema, cytotoxic edema, infarction, hemorrhage,
anesthesiologists other clinicians and investigative
departments could get involved. demyelination). 5 Treatment is mainly for the
symptoms that toxic encephalopathy brings upon
victims, varying depending on how severe the case
Kazi Mesbahuddin Iqbal
is. To reduce or halt seizures, anticonvulsants may
be prescribed. Dialysis or organ replacement surgery
may be needed in some severe cases. 5 Toxic
Images in medical practice: Short communication encephalopathy is often irreversible. If the source of
of Journal of Bangladesh College of Physician and the problem is treated, by removing the toxic chemical
Surgeons, May 2010; 28(2): 128. from the system, further damage can be prevented,
To the editor in chief: At first I thank to the editor for but prolonged exposure to toxic chemicals can
starting some new section like ‘letter to the editor’ quickly destroy the brain. Research is being done by
and short communication. I have gone through the organizations such as NINDS (National Institute of
report and I would like to give some comments about Neurological Disorders and Stroke) on what
Toxic encephalopathy. Toxic encephalopathy, also substances can cause encephalopathy, why they do
known as toxic-metabolic encephalopathy, is a this, and eventually how to protect, treat, and cure
degenerative neurologic disorder caused by exposure the brain from this condition.6 It is increasing day by
to toxic substances.1 It can be an acute or chronic day in our country due to ignorance, illiteracy, poverty
disorder.Toxic encephalopathy has a wide variety of & illegal practice of different substances by local
symptoms, which can include memory loss, small traditional healer. I thank to author to highlight the
personality changes, lack of concentration, case and image which will make awarness among
involuntary movements, nausea, fatigue, seizures and medical practioner about toxic encephalopathy.
depression.2,3 Toxic encephalopathy may be caused
References:
by prolonged exposure to toxic elements including 1. “Neurotoxicity Syndromes”. Medical Subject Headings.
solvents, drugs, radiation, paints, industrial United States National Library of Medicine. 1999-11-03.
chemicals, and certain metals. In addition, chemicals, http://www.nlm.nih.gov/cgi/mesh/2009/
such as lead, that could instigate toxic encephalopathy MB_cgi?mode=&index=18803. Retrieved 2009-03-30.
are sometimes found in everyday products such as 2. “What is Encephalopathy?”. Disorders A-Z. National Institute
cleaning products, building materials, pesticides, air of Neurological Disorders and Stroke. 2007-02-12. http://
fresheners, and even perfumes.3,4 Different kinds of w w w. n i n d s . n i h . g o v / d i s o r d e r s / e n c e p h a l o p a t h y /
lesions, which lack specificity for toxic injury, can encephalopathy.htm#What_is. Retrieved 2009-03-30.
be observe on radiological images, but deep grey 3. Fidler AT, Baker EL, Letz RE. “Neurobehavioural effects of
matter lesions with symmetrical distribution through occupational exposure to organic solvents among construction
out basal ganglia are most often seen. However, such painters”. Occupational and Environmental Medicine May
findings have also been reported after anoxic- 1987;44 (5): 292–308. doi:10.1136/oem.44.5.292. http://
ischemic insults or during severe metabolic oem.bmj.com/cgi/reprint/44/5/292. Retrieved 2009-04-26.
disturbances. Lesions in the white matter may also 4. “National Toxic Encephalopathy Foundation”. http://national-
be present in the case of acute exposure to toxic toxic-encephalopathy-foundation.org/. Retrieved 2009-03-30.
agents. The true prognostic value of toxic-induced 5. Hantson P, Duprez. The value of morphological neuroimaging
brain changes in the acute phase in CT or MR studies after acute exposure to toxic substances. Toxicol Rev.
is unclear, although serial MRI may add new 2006;25(2):87-98.
204
Letter to the Editor
6. “What research is being done?”. Disorders A-Z. National encephalopathy patient. In the short communication,
Institute of Neurological Disorders and Stroke. 2007-02-12. there were little scope of detailed discussion on various
http://www.ninds.nih.gov/disorders/encephalopathy/ expects of toxic encephalopathy but I must appreciate
encephalopathy.htm#What_research_is_being_done. and thank you for your letter highlighting the etiology,
Retrieved 2009-04-12. clinical presentation, diagnostic approach and treatment
of toxic encephalopathy.2 I gladly accept the additional
Dr. Aparna Das information you have provided. It was gratifying to read
Assistant Professor, the response from the reader.
Department of Medicine References:
Dhaka Medical College, Dhaka. 1. Siddiqui MMR, Hossain A, Rahman MU, Islam QT. Images
in Medical Practice: short communication. J Bangladesh Coll
Phys Surg 2010;28(2):128.
Author’s Reply: 2. Das A. Letter to the editor: Images in Medical Practice: short
communication. J Bangladesh Coll Phys Surg 2010.
We pleased to see the keen interest of Dr. Aparna Das
regarding the article “Images in Medical Practice: Short
Dr. Md. Mahmudur Rahman Siddiqui
Communication of JBCPS, May 2010;28(2):128”.1 We
FCPS Med Part-II course student,
appreciate the opportunity to respond. In my short
Department of Medicine, Dhaka Medical College,
communication I wanted to highlight the changes that
Dhaka.
occur in the CT scan and MRI of brain of a toxic
205