NEUROBEHAVIORAL EVALUATION OF RESIDUAL EFFECTS OF ACUTE CHLORINE INGESTION
Raymond Singer, Ph.D.
Santa Fe, New Mexico, and New York, New York1
ABSTRACT
Rationale: Chlorine exposure can lead to respiratory dysfunction resulting in brain cell hypoxia, injury and neurobehavioral disorders.
Assessment approach: Comprehensive neurobehavioral toxicity evaluations were performed on 2 cases, including WAIS, Neurotoxicity Screening Survey, Trailmaking (TT), and memory tests including Benton Visual Retention test (BVRT), Expanded Paired Associates Tests (EPAT), a logical memory test (LM), Selective Reminding Test (SRT), and tests for malingering and distortion.
Summary of findings: Case 1, 59 year old Ph.D., pre-exposure IQ 95th %, was served water contaminated with chlorine disinfectant, went into respiratory distress and treated at the local emergency room. He was examined 3 years post-exposure, and found to have vocal cord dysfunction and sleep apnea, central-type. BVRT showed 9 errors (strong indication of brain impairment); EPAT was at 34th and 17th %; Neurotoxicity Screening Survey was elevated at 236; SRT was at the 8th %; TT was at the 50th and 31st %; and LM < 1st %. Case 2, 40 year old male nurse, pre-exposure IQ at the 63rd%, was examined 1.5 years post-exposure to iced tea contaminated with chlorine. He developed reactive airway disease. Current IQ was at the 32nd %, with specific deficits in immediate memory, visual logic and psychomotor speed, all at the 16th %. BVRT showed 14 errors; EPAT was at 5th and 1st%; Neurotoxicity Screening Survey was elevated at 332; SRT was at 2nd %; TT was at 2nd and 24th %; LM < 1st. Follow-up interviews at 1 and 2 years post-exam indicated continued symptoms. In both cases, all test results of malingering were negative, and medical record review found no other explanations for the declines.
Conclusion: Chlorine ingestion neurotoxicity was found which lasted many years after exposure.
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