Table 1.

Case reports and case series of PDCB toxicity.

Case reports	Age/sex	Probable reason for pica	Mode of exposure	Duration of exposure	Serum level	Clinical manifestations	EEG findings	MRI findings	Outcome
Avila et al. [2006]	21 years, female	Postpartum pica	Oral ingestion	7 months	0.5 mcg/ml	Encephalopathy, nystagmus, ataxia, seizures	Status epilepticus	Diffuse leukoencephalopathy	Improvement of mental status at 2 months
Cheong et al. [2006]	42 years, female	NS	Oral ingestion	2 years	NS	Encephalopathy, tremor, rigidity, ataxia, bradyphrenia and catatonia	Diffuse slowing	Diffuse leukoencephalopathy and involvement of deep cerebellar nuclei bilaterally	Marked improvement of mental status at 6 months
Feuillet et al. [2006]	Case 1: 18 years, female	Case 1: iron deficiency anemia	Inhalation	Case 1 and Case 2: 4–6 months	NS	Case 1: encephalopathy, pyramidal signs, unsteady gait, urinary retention, ichthyosis	Normal	Normal	Case 1: complete recovery at 6 months
	Case 2: twin sister	Case 2: NS				Case 2: pyramidal signs, unsteady gait, ichthyosis			Case 2: complete recovery in 3 months
Reygagne et al. [1992]	16 years, female	NS	Inhalation	Unknown duration	NS	Encephalopathy, bilateral optic neuritis, ataxia	NS	Normal	NS
Miyai et al. [26]	25 years, female	Neurosis	Inhalation	6 years	NS	Dysarthria, moderate weakness in extremities, hyporeflexia, truncal ataxia	Normal	Normal	Marked improvement in 6 months
Weintraub et al. [2000]	54 years, female	Depression	Inhalation initially, followed by oral ingestion	Sniffing since her teens, chewing for 6 years	NS	Progressive weakness in all extremities, peripheral neuropathy	NS	Diffuse leukoencephalopathy, lacunar infarcts of the midbrain and pons	NS
Murray et al. [2010]	31 years, female	Depression	Oral ingestion	2 months	NS	Encephalopathy	Generalized slowing	Diffuse leukoencephalopathy	Improvement at 7 months
Hernandez et al. [2010]	44 years, male	Depression, iron deficiency anemia	Inhalation and oral ingestion	4 months	1.2 mcg/ml	Encephalopathy, hyperreflexia, cogwheel rigidity	Focal slowing in the temporal lobes	Subcortical white matter changes in anterior temporal lobes	Symptoms persisted for >4 months
Kumar et al. [2009]	32 years, female	NS	Inhalation initially followed by ingestion	Mothball sniffing since childhood, ingestion since 2 years	34 mcg/ml	Cognitive decline, dysarthria, limb spasticity, bradykinesia, distal limb weakness, hyperreflexia, ataxia	NS	Diffuse white matter changes	NS
Frank et al. [27]	19 years, female	NS	Oral ingestion	2.5 years	NS	Mental slowing, unsteady gait, upper extremity tremor and icthyosis	NS	NS	Symptoms resolved 4 months post exposure
Passov et al. [2011]	32 year, female	NS	Inhalation	5 years	NS	Amnesia, behavioral changes, dysarthria, generalized weakness, ataxia	NS	Hyperintensity on FLAIR MRI in the brain stem, cerebellar peduncles, perventricular white matter, corpus callosum, and internal capsule	Marked improvement at 8 month follow up
Buckmann et al. [28]	40 years, Female	Depression, anxiety	Oral ingestion	NS	NS	Encephalopathy, ataxia, cogwheel rigidity	NS	Diffuse periventricular white matter disease	Discharged home in stable condition
Hession et al. [2014]	38 years, female	Iron deficiency anemia, depression	Inhalation, and oral ingestion	21 years	18.5 mcg/ml	Encephalopathy, dysconjugate gaze, left lower extremity weakness, urinary incontinence	Diffuse slowing	Hyperintensities on FLAIR in bilateral corona radiata, anterior basis pons, cerebral peduncles	Improvement in cognition at 3 month follow up

FLAIR, fluid attenuated inversion recovery; MRI, magnetic resonance imaging; PDCB, para-dichlorobenzene; NS, not specified.