Case Report Encephalopathy and Neuropathy due to Glue, Paint Thinner, and Gasoline Sniffing in Trinidad and Tobago-MRI Findings Kanterpersad Ramcharan, 1 Amrit Ramesar, 1 Moshanti Ramdath, 1 Joel Teelucksingh, 1 and Maria Gosein 2 1 Neurology Unit and Department of Medicine, San Fernando Teaching Hospital, University of the West Indies, San Fernando, Trinidad and Tobago 2 Department of Radiology, Port of Spain General Hospital, Port of Spain, Trinidad and Tobago Correspondence should be addressed to Kanterpersad Ramcharan; kramcharan79@yahoo.com Received 25 April 2014; Accepted 5 June 2014; Published 18 June 2014 Academic Editor: Reiji Koide Copyright © 2014 Kanterpersad Ramcharan et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. A 29-year-old male petrol station pump attendant was admitted with ataxia and clinical evidence of a sensorimotor polyneuropathy which developed over the preceding 3 months. He had cognitive dysfunction, hearing loss, and cerebellar clinical abnormalities that came on slowly over the three years. He had a ffeen-year history of snifng mostly glue, occasionally paint thinners, and, in the recent two years, gasoline. Magnetic resonance brain imaging showed abnormalities of the cerebral cortex, cerebral white matter, corpus callosum, hippocampus, brainstem and cerebellar atrophy, hypointensities of basal ganglia, red nuclei, and substantia nigra as previously described in toluene snifng. Abstinence for six months led to partial clinical improvement. Clinicians need to be aware of this preventable entity which has peculiar radiological fndings which are being increasingly accepted as typical. 1. Introduction Toluene toxicity from glue, paint thinners, and petrol (gaso- line) snifng is being recognized globally and reports docu- menting the neurotoxic efects of this practice have focused on the multisystem nervous system presentations, the patho- genesis of which is still unclear [1, 2]. Peculiar abnormalities on magnetic resonance imaging, albeit not being common except in severe cases, have been reported repeatedly [3–8]. Inhalant substance abuse has not been a common practice in the West Indies. We report a young man who was introduced to this form of substance abuse at age of 15 by a friend from the United States and presented to hospital 15 years later with ataxia, cognitive abnormalities, and peripheral neuropathy. 2. Case Report A 29-year-old-Afro-Caribbean male presented with a three- month history of difculty in walking with numbness and weakness of the hands and feet which had worsened over the previous 3 months. He had to be supported to walk on admission. Te accompanying brother noted that he had difculty with speech, reading, and writing which had been noted a few years before. He had no chronic illnesses, had no previous surgery, was single, and lived with his parents. He was not a vegetarian and worked as a petrol station attendant. He did not use alcohol, cannabis, tobacco, or cocaine. Tere was no family history of consanguinity or neurological illness. Further questioning as to the possibility of heavy metal poisoning led to a history of glue, paint thinners, and more recently petrol snifng at his workplace. For most of the 15 years, glue snifng was the predomi- nant form of inhalant abuse. He had been introduced to the pleasure of glue snifng at age of 15 by a friend who was visiting from the USA and had abused glue and to a lesser extent paint thinners and gasoline since working as a gas station attendant. He had no bowel or bladder dysfunction but admitted to diminished vision and hearing for about a year. Hindawi Publishing Corporation Case Reports in Neurological Medicine Volume 2014, Article ID 850109, 4 pages http://dx.doi.org/10.1155/2014/850109