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To the Editor:—
A 48-year-old internist in excellent health returned home from the theater late one hot summer night and creosoted some fence posts before retiring. He worked for an hour in a poorly-ventilated garage, but retired feeling completely well. The following morning he noticed diplopia, and an ophthalmologist found the internist to be having difficulty in gazing upward and to both sides. Later he became dysarthric, ataxic, and had some difficulty in thinking clearly. By 2 pm he had developed prominent signs of hemiparesis on the left side, suggestive signs of involvement of the right side of the pyramidal tract, paralysis of the upward gaze and vertical nystagmus as well as nystagmus on gazing to the right and the left, with limitation of vision and diplopia on looking to the right and left. There were no sensory abnormalities and there was no aphasia. Romberg's sign was negative, but the
Arieff AJ, Atlas DH. Acute, Toxic, Polioencephalitis (Creosote). JAMA. 1965;193(9):745. doi:10.1001/jama.1965.03090090051025