Reversible Ethyl Chloride Neurotoxicity: A Case Report

Ethyl chloride is used as a topical anesthetic.1 Its other uses include refrigerant, alkylating agent, electronics head cleaning-solvent, and inhalant to enhance the sexual experience.1 It was previously used in general anesthesia but this practice was discontinued because of availability of safer anesthetics.1 The literature on ethyl chloride neurotoxicity in clinical practice is limited and mainly derived from case reports. Mild tremors Soult et al3 22 Male 4 months; increased 24 hours before presentation Ataxia, vertigo, blurring of vision, diplopia, auditory and visual hallucinations Marked ataxia and horizontal nystagmus, Romberg sign, peripheral cyanosis Complete recovery within 7 days of discontinuation Nordin et al4 52 Male Many years; increased in past 4 months Confusion, disorientation, visual and olfactory hallucinations, dizziness, palpitations, seizure while hospitalized Ataxia, impaired vibration sense in both lower extremities, amnesia and confabulations Alcohol and benzodiazepines abuse Symptoms improved in 6 weeks following hospitalization Demarest et al5 45 Male 5 months; increased 1 week before presentation Difficulty standing or walking unsupported Wide-based gait, bilateral upgoing plantars, symmetrical brisk deep tendon reflexes, bilateral ankle and patellar clonus HIV-positive Symptoms improved on discontinuation of ethyl chloride Senussi et al6 47 Male Night before presentation Dizziness, unsteadiness, speech difficulty Right facial droop, mild dysarthria, mild aphasia, and difficulty with word finding. Mild unsteadiness of gait HIV-positive, chronic hepatitis C virus infection, esophageal varices, right Bell palsy, Crohndisease Symptoms improved within 1 week of ethyl chloride discontinuation Yacoub et a17 20 Male Unknown Found face-down in bed at home with a bottle of ethyl chloride in or beside his right hand Arrived hospital in ventricular fibrillation.