http://www.gulflink.osd.mil/library/randrep/pb_paper/
Chapter Ten: Bromism
http://www.gulflink.osd.mil/library/randrep/pb_paper/mr1018.2.chap10.html
Symptoms of Bromism
Bromide intoxication, from prolonged consumption of excessive doses of bromide, may cause protean
symptoms, particularly psychiatric, cognitive, neurological, and dermatologic. Symptoms may be incorrectly perceived as "psychosomatic" (Pelckmans, Verdickt, et al., 1983), or may lead falsely to other diagnoses.
Psychiatric symptoms may include, in the earlier stages,
disinhibition, self-neglect, fatigue, sluggishness, impairment of memory and concentration, irritability or emotional instability, and depression. Symptoms of more advanced disease may include
confusion but occasionally
schizophrenic-like psychotic behavior or hallucinations in clear consciousness. Behavior may become violent, especially at night. There may be severe auditory or visual hallucinations, or both. There may be clouding of consciousness, including stupor and coma (Horowitz, 1997; Fried and Malek-Ahmadi, 1975; Wacks, Oster, et al., 1990; Carney, 1973).
Neurological abnormalities of "all kinds" occur, including
headache, tremor, slurred speech, spontaneous movements, incoordination, ataxia (abnormal gait), tendon reflex changes (increased or decreased reflexes), and extensor plantar responses (abnormal reflexes that signify "upper motor neuron" disease, disease in the brain or spinal cord that affects nerve signaling to the muscles) (Horowitz, 1997; Fried and Malek-Ahmadi, 1975; Wacks, Oster, et al., 1990; Carney, 1973). Vision changes have included decreased visual acuity often in conjunction with enlarged and poorly reacting pupils; disturbances of color perception, photophobia (abnormal sensitivity to light), micropsia and macropsia (perception of things as smaller or larger than they are), blurring of vision, and the quite characteristic mydriasis (enlarged pupils) (Levin, 1960; Kunze, 1976).
EEG: Generalized slowing of the EEG has been reported (Carney, 1973).
Dermatologic: Some patients will develop
"bromoderma," an acne-like "papular" (raised) eruption of the face and hands (Horowitz, 1997; Wacks, Oster, et al., 1990); a "macular" (nonraised) rash may also be seen (Carney, 1973). In one case series, four of six bromism patients had abnormal pigmentation, usually of the sun-exposed areas (Carney, 1973).
Acute bromism is seldom seen because the bromide ion is irritating to the GI tract and produces vomiting before sufficient blood levels can be reached to cause bromism from short-term use. However, chronic bromism may develop--bromide is excreted slowly through the kidney, giving it the opportunity to build up in the body through ongoing ingestion (Morgan and Weaver, 1969).