A rare case of Holmes tremor in a worker with occupational carbon monoxide poisoning.

Parkinsonism and encephalopathy are frequently seen in patients who survive carbon monoxide (CO) poisoning. Neurological findings associated with CO poisoning can emerge immediately after cessation of exposure or following a brief period of pseudo-recovery. When present, the tremor associated with CO poisoning is typical of the postural/intention type. Here, we report on a rare case of toxic encephalopathy with a dominant-hand Holmes-type tremor, characterized by resting, as well as postural and kinetic/intentional components, in a previously healthy 53-year-old man exposed to CO while actively engaged in the process of performing a physically demanding skilled labor task. The unique neuropathological and functional changes that give rise to Holmes-type tremor and how this relates to the selective vulnerability of the inhibitory indirect pathway of the basal ganglia to glutamatergic excitotoxicity mediated by tissue hypoxia are discussed.

How does an occupational neurologist assess welders and steelworkers for a manganese-induced movement disorder? An international team's experiences in Guanxi, China Part II.

The Occupational Medicine Forum is prepared by the ACOEM Occupational and Environmental Medical Practice Committee and does not necessarily represent an official ACOEM position. The Forum is intended for health professionals and is not intended to provide medical or legal advice, including illness prevention, diagnosis or treatment, or regulatory compliance. Such advice should be obtained directly from a physician and/or attorney.

Occupational medicine physician's guide to neuropathy in the workplace, part 2: electromyography and cryptogenic and toxic neuropathy.

The Occupational Medicine Forum is prepared by the ACOEM Occupational and Environmental Medical Practice Committee and does not necessarily represent an official ACOEM position. The Forum is intended for health professionals and is not intended to provide medical or legal advice, including illness prevention, diagnosis or treatment, or regulatory compliance. Such advice should be obtained directly from a physician and/or attorney. Inquiries and contributions to the Forum should be forwarded to Joseph J. Schwerha, MD, MPH by e-mail at schwer@pitt.edu.

Neurologic issues with solvents.

Reports of injury began after the introduction of chlorinated solvents in the 1920s. In 1987, the National Institute for Occupational Safety and Health reported that 9.8 million workers were exposed to organic solvents in occupational settings, with most of these exposures being to mixtures of solvents. Although solvent mixtures have been noted to be responsible for neuropathy, seizures, and encephalopathy, identifying the culpable agent has been difficult, because the associations between many solvents and their biologic effects have not been well defined, and solvent interaction in mixtures have not been well or easily characterized. In some cases, these exposures have been estimated to be below levels designated in regulations as acceptable for workers.