Abstract：
Mercury is a highly toxic heavy metal that may cause neurological, respiratory, gastrointestinal and dermatological illnesses. Previously described neurological manifestations of mercury toxicity are symmetrical, and include a pancerebellar syndrome, generalised seizures and encephalopathy. Mercury is used in the gold mining process, and in artisanal or illicit gold mining, often without necessary protection. Here we describe the cases of two artisanal gold miners from western Johannesburg, South Africa, who presented with atypical neurological manifestations of mercury toxicity. Patient 1 presented with focal seizures, an asymmetrical cerebellar syndrome and an acute encephalopathy. Patient 2 had unilateral cerebellar ataxia. Both patients had toxic mercury levels, with no other cause identified for their symptoms. Patient 1 responded well to chelation therapy, but patient 2 refused admission and further medical treatment. The neurological manifestations of mercury toxicity are typically symmetrical, whereas our two patients presented with markedly asymmetrical features. It is important to maintain a high index of suspicion for mercury poisoning, even in patients with atypical and unilateral or asymmetrical presentations. A prompt diagnosis and the commencement of early chelation therapy have the potential to produce good outcomes.
摘要：
汞是一种剧毒的重金属，可能会导致神经系统，呼吸,胃肠道和皮肤病。先前描述的汞毒性的神经系统表现是对称的，包括小脑前病变综合征,全身性癫痫和脑病。汞用于黄金开采过程，在手工或非法金矿开采中，往往没有必要的保护。在这里，我们描述了两个来自约翰内斯堡西部的手工金矿开采者的案例，南非,表现为汞毒性的非典型神经系统表现。患者1出现局灶性癫痫发作，不对称小脑综合征和急性脑病。患者2患有单侧小脑共济失调。两个病人都有有毒的汞含量,没有其他原因确定他们的症状。患者1对螯合疗法反应良好，但患者2拒绝入院和进一步治疗.汞中毒的神经表现通常是对称的，而我们的两名患者表现出明显的不对称特征。重要的是要保持对汞中毒的高怀疑指数，即使是非典型和单侧或不对称表现的患者。及时诊断和早期螯合治疗的开始有可能产生良好的结果。
