Tardily accelerated neurologic deterioration in two-step thallium intoxication

Hiroshi Kuroda, Yoshiyuki Mukai, Shuhei Nishiyama, Takayuki Takeshita, Maki Tateyama, Atsushi Takeda, Masashi Aoki

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)


Thallium intoxication was reported in cases with accidental ingestion, suicide attempt, and criminal adulteration. Reported cases were mostly one-time ingestion, therefore, the clinical course of divisional ingestion has not been fully known. Here, we report a case with two-step thallium intoxication manifesting as tardily accelerated neurologic deterioration. A 16-year-old adolescent was cryptically poisoned with thallium sulfate twice at an interval of 52 days. After the first ingestion, neurologic symptoms including visual loss, myalgia, and weakness in legs developed about 40 days after the development of acute gastrointestinal symptoms and alopecia. After the second ingestion, neurologic symptoms deteriorated rapidly and severely without gastrointestinal or cutaneous symptoms. Brain magnetic resonance imaging exhibited bilateral optic nerve atrophy. Nerve conduction studies revealed severe peripheral neuropathies in legs. Thallium intoxication was confirmed by an increase in urine thallium egestion. Most of the neurologic manifestations ameliorated in two years, but the visual loss persisted. The source of thallium ingestion was unraveled afterward because a murder suspect in another homicidal assault confessed the forepast adulteration. This discriminating clinical course may be attributable to the cumulative neurotoxicity due to the longer washout-time of thallium in the nervous system than other organs. It is noteworthy that the divisional thallium intoxication may manifest as progressive optic and peripheral neuropathy without gastrointestinal or cutaneous symptoms.

Original languageEnglish
Pages (from-to)234-236
Number of pages3
JournalJournal of Clinical Neuroscience
Publication statusPublished - 2016 Dec 1


  • Alopecia
  • Mees’ line
  • Optic neuropathy
  • Peripheral neuropathy

ASJC Scopus subject areas

  • Surgery
  • Neurology
  • Clinical Neurology
  • Physiology (medical)


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