Summary: Toxic causes of seizures are numerous: alcohol and other substances of abuse, drugs, and industrial and household products. However, in the absence of a clearly suggestive history and/or associated symptoms and signs, identification of the toxic origin of new-onset seizures may be extremely difficult. We report here the case of a patient admitted in our hospital after a single generalized tonic-clonic seizure. The remarkable coincidence that a colleague of his, with whom he was working to clean the same workshop, had been admitted 1 week earlier for respiratory distress, coma, and de novo nonconvulsive focal status epilepticus, led us to consider a possible toxicologic etiology. Urine analysis revealed a high nickel concentration, suggestive of acute nickel poisoning. Key Words: Seizures-PoisoningNickel.Toxic causes of seizures are numerous: alcohol and other substances of abuse, drugs, and industrial and household products. However, in the absence of a clearly suggestive history and/or associated symptoms and signs, identification of the toxic origin of new-onset seizures may be extremely difficult. We report here the case of a patient admitted in our hospital after a single generalized tonic-clonic seizure. The remarkable coincidence that a colleague of his, with whom he was working to clean the same workshop, had been admitted 1 week earlier for respiratory distress, coma, and de novo nonconvulsive focal status epilepticus, led us to suspect a possible common toxic origin.
CASE REPORTThe patient was a 43-year-old man admitted to our hospital after an inaugural generalized tonic-clonic seizure. His medical and surgical history was unremarkable. The patient did not take or had not recently stopped any medication. He did not abuse alcohol or any other substance and did not recently modify his sleep or food habits. No familial history of epilepsy was known. He had worked for a couple of weeks in a car body-repair workshop where he was cleaning the ceilings of the building. On admission, physical and neurologic examinations were normal, Accepted January 27, 2005. Address correspondence and reprint requests to Dr. D. De Bels at Intensive care Unit, Salle 92, Brugmann University Hospital, Free University of Brussels, 4 Van Gehuchten Plein, B 1020 Brussels, Belgium. E-mail: david.debels@chu-brugmann.be except for a mild drowsiness attributed to a postictal state. No meningeal signs were seen. Prolactin and lactate levels were high on admission, 36.8 ng/ml (2.5-11) and 122.8 mg/dl (9-16), respectively. HbCO was normal (<5%). Glycemia and other routine blood analyses were within normal values. EEG performed a few hours later showed diffuse slow waves. Brain CT and MRI scans were normal. A diagnosis of first idiopathic generalized seizure was presumed, until we were informed that a colleague of the patient, with whom he was working to clean the same workshop, had been admitted 1 week earlier in the same hospital for respiratory distress, coma, and de novo nonconvulsant focal status epilepticus [global aphasia a...