Case Report: Long segmental lesions of the spinal cord caused by exposure to xylene

Abstract

Xylene has the potential to cause nervous system disturbances since it is a lipophilic substance with high affinity for lipid-rich tissue, such as the brain. Involvement in the spinal cord, especially long segmental spinal cord lesions that permeate almost the entire cervical and thoracic spinal cord, is extremely rare. We report two cases of occupational exposure to excessive xylene, both of which presented with severe and rapidly progressive numbness and weakness in the limbs that, more importantly, led to poor outcomes: one died and the other was left severely disabled. In both, spinal magnetic resonance imaging showed long segmental lesions in the cervicothoracic spinal cord. These findings may provide some insights into the effects of xylene as an isolated agent on the spinal cord injury.

Keywords: case report; long segmental lesions; occupational exposure; spinal cord; xylene.

Figure 1

(A–C) Brain MRI of the patient in case 1 indicated high signal intensity of bilateral temporal lobes and insular cortex in a T2WI sequence performed without enhancement on a contrast-enhanced scan (10 days after onset). (D–F) Cervicothoracic MRI of the patient in case 1 showed extensive thickening of the cervical and thoracic spinal cord, especially the cervical spinal cord, and an increased signal intensity in T2WI sequence, with slightly patchy enhancement of the lesions on contrast-enhanced scan (10 days after onset).

Figure 2

(A–C) Brain MRI of the patient in case 2 was normal (2 months after onset). (D–F) Spinal MRI of the patient in case 2 indicated longitudinal linear abnormity with long T2 signal in the cervical and thoracic spinal cord and was not enhanced on the contrast-enhanced scan (2 months after onset).