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What heavy metal exposures result in neuropathies?
1. Lead
In children, lead exposure leads to cognitive problems; however, in adults, exposure is more likely to lead to a neuropathy associated with abdominal pain and anemia. An axonal multifocal motor neuropathy with radial neuropathy is most common though distal symmetric sensory loss can also be seen.
2. Arsenic
Toxicity results in an acute or more chronic axonal sensorimotor neuropathy. Acutely, nausea, vomiting, abdominal pain, psychosis, and seizures are seen while chronic exposure causes Mee’s lines, hyperpigmentation, and palmar/solar keratoses.
3. Thallium
Acute toxicity causes a painful sensory neuropathy associated with alopecia. Chronic exposure produces an axonal sensorimotor neuropathy.
4. Mercury
While primarily mercury causes cognitive and behavioral changes as well as ataxia, subacute exposure to the vapors can cause a motor axonal neuropathy and more chronic exposure causes a painful axonal sensorimotor polyneuropathy.
