Toxic polyneuropathy due to glue-sniffing: Report of two cases with a light and electron-microscopic study of the peripheral nerves and muscles

Abstract Two patients with polyneuropathy following glue-sniffing are reported. They were 20- and 19-year-old painters in the same workshop who each developed a subacute, predominantly motor polyneuropathy after sniffing glue vapours for 3 and 2.5 years respectively. The polyneuropathy progressed for 3 months even after exposure ceased and marked weakness of the extremities with severe neurogenic atrophy of skeletal muscle was distinctive. The glue was proved by gas liquid chromatography to contain both n -hexane and toluene as volatile substances. While n -hexane seems likely to have been the major cause, toluene may have participated in producing the polyneuropathy. Sural nerve biopsies demonstrated extensive nerve damage due to axonal degeneration especially in large diameter fibres. There was no evidence of regeneration in the nerves even 3 months after exposure ceased. It is concluded that n -hexane plus toluene, but especially n -hexane, acted on the axis cylinders of the peripheral nerves, resulting in axonal degeneration, thus producing a predominantly motor polyneuropathy with marked neurogenic muscular atrophy.