An EMG case report of lead neuropathy 19 years after a shotgun injury

The clinical picture of lead neuropathy was classically described as a painless progressive motor neuropathy with axonal loss. The literature review fails to demonstrate a consensus on the site of axonal loss. This is an EMG report of a patient who developed a late lead neuropathy after a shotgun injury. A 69‐year‐old Filipino, healthy, male nondrinker sustained a shotgun injury to his left elbow. Nineteen years later he developed abdominal pain, followed by generalized weakness, distal greater than proximal in the extremities, and impaired pin‐prick, proprioception, and two‐point discrimination. He became nonambulatory and totally dependent in daily activities. He was lost to follow‐up for 2 years until January 1993 when he presented with a blood lead level of 84 μ/dL. EMG examination revealed a sensorimotor peripheral polyneuropathy with severe axonal loss. This case demonstrates that axonal loss is the predominant feature in lead neuropathy and the location of pathology is in the peripheral nerves.© 1995 John Wiley &Sons, Inc.