Lead encephalopathy in an infant mimicking a neurometabolic disorder

Radiological changes in lead poisoning

INTRODUCTION

Lead poisoning in childhood remains an important public health concern. We highlight the radiological findings in a patient with a high blood lead concentration.

CASE SUMMARY

A 7-year-old girl presented to hospital with abdominal pain, nausea, and asthenia. Laboratory tests showed severe hypochromic microcytic anemia, punctate basophilic stippling of erythrocytes, and a blood lead concentration of 880 µg/L (4.3 µmol/L).

IMAGES

Radiographs of the femur, tibia, and fibula demonstrated dense metaphyseal bands ("lead lines"). On cranial computed tomography, we observed multiple speck-like and curvilinear hyperdensities involving subcortical regions, putamen, and left cerebellar hemisphere.

CONCLUSION

In patients with lead poisoning, imaging of the brain and bones may show characteristic features. These imaging findings may point to the diagnosis of lead toxicity when these radiographic findings are discovered during the evaluation of vague complaints such as abdominal pain or mental status changes or when a blood lead concentration is not readily available.

A systematic review of clinical and laboratory findings of lead poisoning: lessons from case reports

Lead is one of the most toxic heavy metals in the environment. The present review aimed to highlight hazardous pollution sources, management, and review symptoms of lead poisonings in various parts of the world. The present study summarized the information available from case reports and case series studies from 2009 to March 2020 on the lead pollution sources and clinical symptoms. All are along with detoxification methods in infants, children, and adults. Our literature compilation includes results from 126 studies on lead poisoning. We found that traditional medication, occupational exposure, and substance abuse are as common as previously reported sources of lead exposure for children and adults. Ayurvedic medications and gunshot wounds have been identified as the most common source of exposure in the United States. However, opium and occupational exposure to the batteries were primarily seen in Iran and India. Furthermore, neurological, gastrointestinal, and hematological disorders were the most frequently occurring symptoms in lead-poisoned patients. As for therapeutic strategies, our findings confirm the safety and efficacy of chelating agents, even for infants. Our results suggest that treatment with chelating agents combined with the prevention of environmental exposure may be an excellent strategy to reduce the rate of lead poisoning. Besides, more clinical studies and long-term follow-ups are necessary to address all questions about lead poisoning management.

Prenatal lead exposure impacts cross-hemispheric and long-range connectivity in the human fetal brain

Lead represents a highly prevalent metal toxicant with potential to alter human biology in lasting ways. A population segment that is particularly vulnerable to the negative consequences of lead exposure is the human fetus, as exposure events occurring before birth are linked to varied and long-ranging negative health and behavioral outcomes. An area that has yet to be addressed is the potential that lead exposure during pregnancy alters brain development even before an individual is born. Here, we combine prenatal lead exposure information extracted from newborn bloodspots with the human fetal brain functional MRI data to assess whether neural network connectivity differs between lead-exposed and lead-naïve fetuses. We found that neural connectivity patterns differed in lead-exposed and comparison groups such that fetuses that were not exposed demonstrated stronger age-related increases in cross-hemispheric connectivity, while the lead-exposed group demonstrated stronger age-related increases in posterior cingulate cortex (PCC) to lateral prefrontal cortex (PFC) connectivity. These are the first results to demonstrate metal toxicant-related alterations in human fetal neural connectivity. Remarkably, the findings point to alterations in systems that support higher-order cognitive and regulatory functions. Objectives for future work are to replicate these results in larger samples and to test the possibility that these alterations may account for significant variation in future child cognitive and behavioral outcomes.

"Beginning with the Smallest Intake": Children's Brain Development and the Role of Neuroscience in Global Environmental Health

Early exposure to environmental toxins like lead, air pollution, and arsenic can have long-lasting and irreversible consequences for children's neurodevelopment, especially in the developing world. Though the number of pollutants increases each year, some neuroscientists are forging partnerships to improve measurement, raise awareness, and promote global health.

Occupation and the risk of chronic toxic leukoencephalopathy

Among the hundreds of environmental insults capable of inducing nervous system injury, a small number can produce clinically significant damage to the brain white matter. The use of magnetic resonance imaging (MRI) in affected individuals has greatly illuminated this previously obscure area of neurotoxicology. Toxic leukoencephalopathy has acute and chronic forms, in both of which cognitive dysfunction is the major clinical manifestation. Chronic toxic leukoencephalopathy (CTL) has been most thoroughly described in individuals with intense and prolonged exposure to leukotoxins, but the consequences of lesser degrees of exposure are not well understood. Rare cases of CTL have been reported in workers exposed to culpable leukotoxins, but study of this syndrome is hindered by many confounds such as uncertain level of toxin exposure, the presence of multiple toxins, vague dose-response relationship, comorbid medical or neurologic disorders, psychiatric illness, and legal issues. The risk of CTL in workers is low, although it is not possible to determine quantitative risk estimates. More knowledge can be expected with the application of advanced MRI techniques to the assessment of workers who may have been exposed to known or potential leukotoxins. Preventive measures for avoiding workplace CTL will be informed by clinical assessment involving the use of advanced neuroimaging and neuropsychologic evaluation in combination with accurate measurement of leukotoxin exposure.

Effects of developmental stress and lead (Pb) on corticosterone after chronic and acute stress, brain monoamines, and blood Pb levels in rats

Despite restrictions, exposure to lead (Pb) continues. Moreover, exposure varies and is often higher in lower socioeconomic status (SES) families and remains a significant risk to cognitive development. Stress is another risk factor. Lower SES may be a proxy for stress in humans. When stress and Pb co-occur, risk may be increased. A few previous experiments have combined Pb with intermittent or acute stress but not with chronic stress. To determine if chronic developmental stress affects outcome in combination with Pb, we tested such effects on growth, organ weight, brain monoamines, and response to an acute stressor. Sprague Dawley rats were gavaged with Pb acetate (1 or 10 mg/kg) or vehicle every other day from postnatal day (P)4-29 and reared in standard or barren cages. Subsets were analyzed at different ages (P11, 19, 29). Chronic stress did not alter blood Pb levels but altered HPA axis response during early development whereas Pb did not. Pb treatment and rearing each altered organ-to-body weight ratios, most notably of thymus weights. Both Pb and rearing resulted in age- and region-dependent changes in serotonin and norepinephrine levels and in dopamine and serotonin turnover. The model introduced here may be useful for investigating the interaction of Pb and chronic developmental stress.