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The Neuropsychiatric Sequelae of Mercury Poisoning

The Mad Hatter's Disease Revisited

Published online by Cambridge University Press:  02 January 2018

R. E. O'Carroll*
Affiliation:
MRC Brain Metabolism Unit, Royal Edinburgh Hospital, Edinburgh
G. Masterton
Affiliation:
Department of Psychological Medicine, Royal Infirmary of Edinburgh, Edinburgh
N. Dougall
Affiliation:
MRC Brain Metabolism Unit, Royal Edinburgh Hospital, Edinburgh
K. P. Ebmeier
Affiliation:
MRC Brain Metabolism Unit, Royal Edinburgh Hospital, Edinburgh
G. M. Goodwin
Affiliation:
MRC Brain Metabolism Unit, Royal Edinburgh Hospital, Edinburgh
*
Dr R. E. O'Carroll, MRC Brain Metabolism Unit, Royal Edinburgh Hospital, Morningside Park, Edinburgh EH10 5HF. Fax: 031 537 6110

Extract

Background

The detailed effects of mercury poisoning on cognitive function, brain anatomy and regional brain function are largely unknown. We report the case of a 38-year-old man who was exposed to toxic levels of inorganic mercury.

Method

Four years after exposure, the patient was assessed using magnetic resonance imaging (MRI), single-photon emission computerised tomography (SPECT) and detailed neuropsychological evaluation.

Results

The patient developed a myriad of physical and psychiatric complaints, including stomatitis, muscle spasm, tremor, skin rash and the psychiatric syndrome known as ‘erythism’ (Mad Hatter's disease). Neuropsychological evaluation revealed marked and significant deficits of attention concentration, particularly when under time pressure. The MRI scan was unremarkable; however, SPECT revealed hypermetabolism of the posterior cingulate cortex.

Conclusions

Mercury poisoning appeared to result in a dysregulation of posterior cingulate cortex, which was associated with attention/concentration deficits and marked anxiety/agitation.

Type
Papers
Copyright
Copyright © 1995 The Royal College of Psychiatrists 

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References

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