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A toxic shot from the hip
  1. Judith W P M Oomen1,
  2. Bart W Smits2,
  3. Dorine W Swinkels3,
  4. Berend W Schreurs1,
  5. Bastiaan R Bloem2,
  6. Mathijs P Hendriks4
  1. 1Department of Orthopaedic Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  2. 2Department of Neurology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  3. 3Department of Clinical Chemistry, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  4. 4Department of Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  1. Correspondence to Dr Berend Schreurs, Department of Orthopedic Surgery 357, Radboud University Nijmegen Medical Centre, PO Box 9101, Nijmegen 6500 HB, The Netherlands; b.schreurs{at}orthop.umcn.nl

Abstract

A 26-year-old man developed a movement disorder characterised by bradyphrenia, bradykinesia, rigidity, tremor and dystonia, several years after having been shot by a gun in the hip. Laboratory investigations revealed anaemia and porphyria. The authors demonstrate that his neurological condition was a delayed manifestation of lead toxicity, caused by slow absorption of lead from persisting bullet fragments in the hip joint. Treatment with excision of the femoral head and debridement of the hip followed by a total hip, in combination with chelating therapy, led to a remarkable remission.

  • Tremor
  • gait disorders/ataxia
  • basal ganglia
  • other toxicology
  • lead encephalopathy
  • cerebellar ataxia
  • gait
  • movement disorders
  • toxicology

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Footnotes

  • Funding BRB was supported by a ZonMw VIDI research grant (no 016.076.352).

  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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