Advertisement

Treatment of Experimental Acute Lead Encephalopathy

  • Raymond A. Clasen
  • Sylvia Pandolfi
  • Thomas J. Hoeppner
  • Jaclynn R. Clasen

Abstract

The current recommendations for therapy in acute lead encepha-lopathy are the immediate use of calcium disodium ethylenediamine-tetraacetate (EDTA) and dimercaptopropanol (BAL) in combination1. These chelating agents bind and inactivate lead ions. The complex is then rapidly excreted by the kidney. Also recommended to reduce the accompanying cerebral edema are restrictions of fluids and the judicious use of mannitol. To our knowledge it has not been objectively demonstrated that intravenous hypertonic solutions do indeed reduce the edema of lead encephalopathy, but clinical improvement of patients, so treated, has been reported12. The use of steroids has also been reported on clinical grounds as being both effective10 and ineffective13.

Keywords

Cerebral Edema Vasogenic Edema Edema Fluid Invert Sugar Calcium Disodium 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Albert JJ et al: Prevention, diagnosis, and treatment of lead poisoning in childhood (Report of the American Academy of Pediatrics Subcommittee on Accidental Poisoning). Pediat. 44: 291–298 (1969).Google Scholar
  2. 2.
    Bakay L and Lee JC: Cerebral Edema. Charles C Thomas, Springfield, IL 12–28 (1975).Google Scholar
  3. 3.
    Beks JWF, Ter Weeme CA: The influence of urea and mannitol on increased intraventricular pressure in cold-induced cerebral edema. Acta Neurochir. 16: 97–107 (1967).CrossRefGoogle Scholar
  4. 4.
    Chisolm JJ: The use of chelating agents in the treatment of acute and chronic lead introxication in childhood. J. Pediat. 73: 1–38 (1968).CrossRefGoogle Scholar
  5. 5.
    Clasen RA, Cooke PM, Pandolfi S, Carnecki G, Bryar G: Hypertonic urea in experimental cerebral edema. Arch. Neurol. 12: 424–434 (1965).CrossRefGoogle Scholar
  6. 6.
    Clasen RA, Pandolfi S, Hass GM: Vital staining, serum albumin and the blood brain-barrier. J. Neuropath. 29: 266–284 (1970).CrossRefGoogle Scholar
  7. 7.
    Clasen RA, Hartman JF, Starr AJ, Coogan PS, Pandolfi S, Laing I, Becker R, Hass GM: Electron microscopic and chemical studies of the vascular changes and edema of lead encephalopathy. Amer. J. Path. 74: 215–234 (1974).Google Scholar
  8. 8.
    Clasen RA, Pandolfi S, Clasen JR: Massive doses of steroids in cryogenic cerebral injury and edema. Stroke 10: 670–673 (1979).CrossRefGoogle Scholar
  9. 9.
    Clasen RA, Bezkorovainy A, Pandolfi S: Protein and electrolyte changes in experimental cerebral edema J. Neuropath. Exp. Neurol. 41: 113–128 (1982).CrossRefGoogle Scholar
  10. 10.
    Coffin R, Phillips JL, Staples WI, Spector S: Treatment of lead encephalopathy in children. J. Pediat. 69: 198–206 (1966).CrossRefGoogle Scholar
  11. 11.
    Cooper PR, Moody S, Clark WK, Kirkpatrick J, Maravilla K, Gould AL, Drane W: Dexamethasone and severe head injury, a prospective double blind study. J. Neurosurg. 51: 307–316 (1979).CrossRefGoogle Scholar
  12. 12.
    Greengard J, Rowley W, Elam H, Perlstein M: Lead encephalopathy in children: intravenous use of urea in its management. New Eng. J. Med. 264: 1027–1031 (1961).CrossRefGoogle Scholar
  13. 13.
    Greengard J, Adams B, Berman E: Acute lead encephalopathy in young children; evaluation of therapy with a cortisteroid and moderate hypothermia. J. Pediat. 66: 707–711 (1965).CrossRefGoogle Scholar
  14. 14.
    Guisado R, Arieff AI, Massry SG: Effects of glycerol administration on experimental brain edema. Neurol. 26: 69–75 (1976).Google Scholar
  15. 15.
    Hindo WA, Clasen RA, Rayudu GVS, Pandolfi S: Technetium in cryogenic cerebral injury and edema. Arch. Neurol. 27: 526–534 (1972).CrossRefGoogle Scholar
  16. 16.
    Katzman R, Clasen RA, Klatzo I, Meyer JS, Pappius HM, Waltz AG: Brain edema in stroke. Stroke 8: 509–540 (1977).CrossRefGoogle Scholar
  17. 17.
    Lampert P, Garro F, Pentschew A: Lead encephalopathy in suckling rats. In: Brain Edema, Eds. Klatzo I, Scitelberger F, Springer-Verlag, New York, p 207–222 (1967).CrossRefGoogle Scholar
  18. 18.
    Pappius HM, Dayes LA: Hypertonic urea: its effect on the distribution of water and electrolytes in normal and edematous brain tissues. Arch. Neurol. 13: 395–402 (1965).CrossRefGoogle Scholar
  19. 19.
    Pappius HM, McCann WP: Effects of steroids on cerebral edema in cats. Arch. Neurol. 20: 207–216 (1969).CrossRefGoogle Scholar
  20. 20.
    Reed DJ, Woodbury DM: The effect of hypertonic urea solution on electroshock seizure threshold and electrolyte distribution in rats. J. Pharmacol. Exp. Therap. 146: 154–159 (1964).Google Scholar
  21. 21.
    Reulen JH: Vor-und Nachteile der osmotischen Behandlung des Hirnödems. Zentralbl. Neurochir. 26: 234–249 (1965).Google Scholar
  22. 22.
    Spector RG: Water content of the brain in anoxic-ischemic encephalopathy in adult rats. Brit. J. Exp. Path. 42: 623–630 (1961).Google Scholar

Copyright information

© Plenum Press, New York 1984

Authors and Affiliations

  • Raymond A. Clasen
    • 1
  • Sylvia Pandolfi
    • 1
  • Thomas J. Hoeppner
    • 1
  • Jaclynn R. Clasen
    • 1
  1. 1.Departments of Pathology and NeurologyLuke’s Medical CenterChicagoJapan

Personalised recommendations