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Five cases of severe encephalopathy due to chronic ingestion of bismuth have been studied by cerebral computed tomography (CT). In every case, areas of increased attenuation coefficient in the basal ganglia and the cortex of the cerebral hemispheres were demonstrated. These regions of increased attenuation were diffuse with irregular, patchy denser areas. The increased attenuation in the gray matter territories contrasted with decreased attenuation of the white matter, particularly evident in the centrum semiovale of each hemisphere and probably related to edema. Some ventricular dilatation was also present in three cases. In one patient, areas of increased attenuation were demonstrated in the cerebellum. Follow-up CT studies of one patient revealed regression of the pathological findings. This regression accompanied the clinical improvement, which, in every case, followed the termination of the bismuth intake.

Acute myoclonic encephalopathy related to the ingestion of bismuth salts has been known for 3 years and would appear to be reversible. Of a total of 41 cases, 32 were observed for an average of more than a year. Alongside the commoner benign forms, there coexist severe forms, sometimes fatal, prolonged forms and complicated forms. Permanent deterioration, affecting memory above all, tremor, marked insomnia, headache and disturbed gait are amongst the most durable complications, sometimes definitive, whilst in four cases osteo-arthropathy of the shoulders was associated with permanent invalidism.