Skip to main content
Log in

Acute hexachlorophene encephalopathy: Clinico-neuropathological correlation

  • Original Investigations
  • Published:
Acta Neuropathologica Aims and scope Submit manuscript

Summary

This is the first report of neuropathologic findings following oral ingestion of hexachlorophene in the human. The patient was a 7 year old boy who accidentally ingested 45 ml (approx.) of pHisoHex (hexachlorophene).Toxic reactions included nausea, vomiting, anorexia, diarrhea, decrease in visual acuity, blurred vision blindness, somnolence and disorientation. He developed cardiac arrhythmia, fever, isoelectric EEG and finally respiratory and cardiac arrest 61 h after admission.

Autopsy findings showed interstitial myocarditis, pneumonitis and acute bronchiolitis. The brain was edematous. Light microscopy revealed mild diffuse vacuolization of white matter, occasional neuronal degeneration, most prominent on deepest layers of the visual cortex. Disintegration of myelin sheaths and necrosis of axon cylinders were present throughoutoptic pathways. Electron microscopy revealed large, empty extracellular and intramyelinic spaces formed by splitting and separation of the myelin lamellae. These changes are known to occur in experimental animals intoxicated with hexachlorophene, triethyltin, isonicotinic acid hydrazide and cuprizone. However, with respect to hexachlorophene, the localization of lesions to be optic pathways appears to be dependent upon an oral route of administration.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Adornato, B., Lampert, P.: Status spongiosus of the nervous tissue. Acta neuropath. (Berl.)19, 271–289 (1971)

    Google Scholar 

  • Adornato, B., O'Brien, J. S., Lampert, P. W., Roe, T. F., Neustein, H. B.: Cerebral spongy degeneration of infancy. Neurology (Minneap.)22, 202–210 (1972)

    Google Scholar 

  • Aleu, F., Katzman, R., Terry, R. D.: Fine structure and electrolyte analysis of cerebral edema induced by alkyltin intoxication. J. Neuropath. exp. Neurol.22, 403–414 (1963)

    Google Scholar 

  • Herter, W. B.: Hexachlorophene poisoning. Kaiser F. med. Bull.7, 228 (1959)

    Google Scholar 

  • Hirano, A., Zimmerman, H. M., Levine, S.: Intramyelinic and extracellular spaces in Triethyltin intoxication. J. Neuropath. exp. Neurol.27, 571–580 (1968)

    Google Scholar 

  • Hirano, A.: The fine structure of brain in edema. The structure and function of nervous tissue, pp. 69–135. G. H. Bourne, Ed., Vol. II. New York-London: Academic Press 1969

    Google Scholar 

  • Kimbrough, R. D., Gaines, T. B.: Hexachlorophene effects on the rat brain. Study of high doses by light and electron microscopy. Arch. environm. Hlth23, 114–118 (1971)

    Google Scholar 

  • Kimbrough, R. D.: Review of the toxicity of hexachlorophene. Arch. environm. Hlth23, 119–122 (1971)

    Google Scholar 

  • Klatzo, I.: Neuropathological aspects of brain edema. J. Neuropath. exp. Neurol.26, 1–14 (1967)

    Google Scholar 

  • Klatzo, I., Seitelberger, F.: Editor's. Symposium of brain edema, Vienna 1965. Berlin-Heidelberg-New York: Springer 1967

    Google Scholar 

  • Larson, D. L.: Studies show hexachlorophene causes burn syndrome. Hospitals (N.Y.)42, 63–64 (1968)

    Google Scholar 

  • Lampert, P., O'Brien, J., Garrett, R.: Hexachlorophene encephalopathy. Acta neuropath. (Berl.)23, 326–333 (1973)

    Google Scholar 

  • Lampert, P., Schochet, S.: Electron microscopic observations on experimental spongy degeneration of the cerebellar white matter. J. Neuropath. exp. Neurol.27, 210–220 (1968)

    Google Scholar 

  • Lampert, P. W., O'Brien, J. S., Kaye, W. H., Davis, R. L., McCormick, W. F.: Hexachlorophene encephalopathy. J. Neuropath. Neurol.31, 178 (1972)

    Google Scholar 

  • Mullick, F. G.: hexachlorophene toxicity—Human experience at the Armed Forces Institute of pathology. Pediatrics51, 395–399 (1973)

    Google Scholar 

  • Nakaue, H. S., Dost, F. N., Buhler, D. R.: Studies on the toxicity of hexachlorophene in the rat. Toxicol. appl. Pharmacol.24, 239–249 (1973)

    Google Scholar 

  • Pilapil, V. R.: Hexachlorophene toxicity in an infant. Amer. J. Dis. Child111, 333–336 (1966)

    Google Scholar 

  • Plueckhahn, V. D., Banks, J.: Hexachlorophene Toxicity, the new-born child and the staphylococcus. Med. J. Aust.1, 897–903 (1972)

    Google Scholar 

  • Powell, H., Swarner, O., gluck, L., Lampert, P.: Hexachlorophene myelinopathy in premature infants. J. Pediat.82, 976–981 (1973)

    Google Scholar 

  • Rose, A. L., Wisniewski, H. M., Cammer, W.: New observations on hexachlorophene neurotoxicity in rats (Abstract). J. Neuropath. exp. Neurol.33, 176 (1974)

    Google Scholar 

  • Shuman, R. M., Leech, R. W., Alvord, E. C.: Neurotoxicity of hexachlorophene in human infants; A histopathologic study of 250 infants. J. Amer. med. Ass.224, 176–178 (1973a)

    Google Scholar 

  • Shuman, R. M., Leech, R. W., Alvord, E. C., Sumi, S. M.: Experimental neurotoxicity of phisoHex (Abstract). J. Neuropath. exp. Neurol.33, 195 (1974)

    Google Scholar 

  • Suzuki, K., Kikkawa, Y.: Status spongiosus of CNS and hepatic changes induced by cuprizone. Amer. J. Path.54, 307–325 (1969)

    Google Scholar 

  • Wear, J. B., Shanahan, R., Ratliff, R. K.: Toxicity of ingested hexachlorophene. J. Amer. med. Ass.181, 587–589 (1962)

    Google Scholar 

  • Webster, H. de F., Ulsamer, A. G., O'Connel, M.: Acute effects of hexachlorophene on the developing nervous system in xenopus tadpoles: Morphological and biochemical observations. Abstract. J. Neuropath. exp. Neurol.33, 176 (1974)

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Martinez, A.J., Boehm, R. & Hadfield, M.G. Acute hexachlorophene encephalopathy: Clinico-neuropathological correlation. Acta Neuropathol 28, 93–103 (1974). https://doi.org/10.1007/BF00710320

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00710320

Key words

Navigation