Another brick in the wall: is hexane neuropathy a ‘nodo-paranodopathy’?

  • Sezin Alpaydin BasloEmail author
  • Oya Ozturk
  • Cengiz Dayan
  • Dilek Atakli
  • Mehmet Baris Baslo
Original article


n-Hexane gives cause to one of the most common toxic polyneuropathies seen in poorly ventilated factories. It is a sensory-motor polyneuropathy ending up with axonal degeneration. Nerve biopsy reveals paranodal axonal swelling and secondary myelin retraction in early stages. Myelin retraction imitates demyelination causing focal conduction block and failure before axonal degeneration emerges. This brings to mind the new category of nodo-paranodopathy described first for anti-ganglioside antibody-mediated neuropathies, which can be proved by electrophysiological re-evaluations. We, herein, discuss the clinical and electrophysiological follow-up of three patients with n-hexane neuropathy and remark overlaps with new concept nodo-paranodopathy.


n-Hexane Toxic neuropathy Nodo-paranodopathy Conduction block Polyneuropathy 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Spencer PS, Schaumburg HH (1975) Experimental neuropathy produced by 2,5-hexanedione a major metabolite of the neurotoxic industrial solvent methyl n-butyl ketone. J Neurol Neurosurg Psychiatry 8:771–775CrossRefGoogle Scholar
  2. 2.
    Cianchetti C, Abbritti G, Petriconi G, Siracusa A, Curradi F (1976) Toxic polyneuropathy of shoe-industry workers. A study of 122 cases. J Neurol Neurosurg Psychiatry 39:1151–1161CrossRefGoogle Scholar
  3. 3.
    Chang AP, England JD, Garcia CA, Sumner AJ (1998) Focal conduction block in n-hexane polyneuropathy. Muscle Nerve 21:964–969CrossRefGoogle Scholar
  4. 4.
    Pastore C, Izura V, Marhuenda D, Prieto MJ, Roel J, Cardona A (2002) Partial conduction blocks in n-hexane neuropathy. Muscle Nerve 26:132–135CrossRefGoogle Scholar
  5. 5.
    Oge AE, Yazici J, Boyaciyan A, Eryildiz D, Ornek I, Konyalioglu R, Cengiz S, Oksak OZ, Asar S, Baslo A (1994) Peripheral and central conduction in n-hexane polyneuropathy. Muscle Nerve 17:1416–1430CrossRefGoogle Scholar
  6. 6.
    Kuwabara S, Nakajima M, Tsuboi Y, Hirayama K (1993) Multifocal conduction block in n-hexane neuropathy. Muscle Nerve 16:1416–1417Google Scholar
  7. 7.
    Uncini A, Susuki K, Yuki N (2013) Nodo-paranodopathy: beyond the demyelinating and axonal classification in anti-ganglioside antibody-mediated neuropathies. Clin Neurophysiol 124:1928–1934CrossRefGoogle Scholar
  8. 8.
    Uncini A, Kuwabara S (2015) Nodopathies of the peripheral nerve: an emerging concept. J Neurol Neurosurg Psychiatry 86:1186–1195CrossRefGoogle Scholar
  9. 9.
    Kokubun N, Nishibayashi M, Uncini A, Odaka M, Hirata K, Yuki N (2010) Conduction block in acute motor axonal neuropathy. Brain 133:2897–2908CrossRefGoogle Scholar
  10. 10.
    Uncini A, Vallat JM (2018) Autoimmune nodo-paranodopathies of peripheral nerve: the concept is gaining ground. J Neurol Neurosurg Psychiatry 89:627–635CrossRefGoogle Scholar
  11. 11.
    Delmont E, Manso C, Querol L, Cortese A, Berardinelli A, Lozza A, Belghazi M, Malissart P, Labauge P, Taieb G, Yuki N, Illa I, Attarian S, Devaux JJ (2017) Autoantibodies to nodal isoforms of neurofascin in chronic inflammatory demyelinating polyneuropathy. Brain 140:1851–1858CrossRefGoogle Scholar
  12. 12.
    Vallat JM, Mathis S, Magy L, Bounolleau P, Skarzynski M, Heitzmann A, Manso C, Devaux J, Uncini A (2018) Subacute nodopathy with conduction blocks and anti-neurofascin 140/186 antibodies: an ultrastructural study. Brain 141(7):e56CrossRefGoogle Scholar
  13. 13.
    Vural A, Doppler K, Meinl E (2018) Autoantibodies against the node of ranvier in seropositive chronic inflammatory demyelinating polyneuropathy: diagnostic, pathogenic, and therapeutic relevance. Front Immunol 14(9):1029CrossRefGoogle Scholar
  14. 14.
    Yokoyama K, Feldman RG, Sax DS, Salzsider BT, Kucera J (1990) Relation of distribution of conduction velocities to nerve biopsy findings in n-hexane poisoning. Muscle Nerve 13:314–320CrossRefGoogle Scholar
  15. 15.
    Kuwabara S, Kai MR, Nagase H, Hattori T (1999) n-Hexane neuropathy caused by addictive inhalation: clinical and electrophysiological features. Eur Neurol 41:163–167CrossRefGoogle Scholar
  16. 16.
    Perbellini L, Brugnone F, Gaffuri E (1981) Neurotoxic metabolites of “commercial hexane” in the urine of shoe factory workers. Clin Toxicol 18:1377–1385CrossRefGoogle Scholar
  17. 17.
    Governa M, Calisti R, Coppa G, Tagliavento G, Colombi A, Troni W (1987) Urinary excretion of 2,5-hexanedione and peripheral polyneuropathies workers exposed to hexane. J Toxicol Environ Health 20:219–228CrossRefGoogle Scholar

Copyright information

© Belgian Neurological Society 2019

Authors and Affiliations

  1. 1.Department of Neurology, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric, Neurologic, and Neurosurgical DiseasesUniversity of Health SciencesBakırköyTurkey
  2. 2.Department of Neurology, Istanbul Medical FacultyIstanbul UniversityIstanbulTurkey

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