Survivors from β-fluoroethyl acetate poisoning show a selective cerebellar syndrome

Aim/background: beta-Fluoroethyl acetate (FEA), a derivative of sodium fluoroacetate (Compound 1080, FA), is one of the high-potency toxic chemicals, and it has been used against rats and wild animals. Human casualties from FA or FEA poisoning, accidental or suicidal, have been reported. Survivors of the poisoning are extremely rare. The objective of this study is to present survivors of FEA poisoning. Method: Data on the survivors were collected at the Department of Neurology over the past 20 years. Reviews of the medical record and brain imaging were performed. Results: A total of 10 survivors of FEA poisoning were found. All of the cases were suicide attempts. The amount of FEA ingested varied from 600 to 1800 mg with a mean of 1200 mg, which is close to the lethal dose of FEA. Immediately after ingestion, all of the patients had an altered mental status. On awakening, all of the patients had severe cerebellar dysfunction, such as ataxic gait, dysarthria and intention tremor. The cerebellar dysfunction usually improved gradually over the years after the event, but this improvement eventually plateaued, resulting in residual and persistent cerebellar dysfunction. Serial imaging showed swelling in the posterior fossa during the acute phase and progressive cerebellar atrophy on follow-up. Conclusion: In summary, FEA poisoning causes a selective cerebellar syndrome in its survivors. The pathomechanism underlying the selective cerebellar toxicity of FEA remains to be elucidated. The selective involvement of the cerebellum might provide a useful model for cerebellar degeneration.