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Case Report

Distal symmetrical polyneuropathy due to organophosphate intoxication

Semih Alay, Mehmet Guney Senol, Tansel Kendirli, Erdem Togrol, Mehmet Saracoglu.

While a cholinergic crisis picture is onset in intoxication of organophosphate compounds; a severe polyneuropathy mainly affecting the motor fibers is viewed lately following weeks. Cholinergic crisis may require intubation meanwhile lately onset neuropathy may be characterized by cranial nerve palsies, a hazy vision, ataxia and skin paresthesia. Exposure to substance could be progressed by respiratory tract and skin. 20-year-old male patient with muscle weakness and thinning in the hands and legs was admitted to our outpatient clinic. In his story; he had suicidal drunk pesticide 6 months ago, hospitalized due to loss of consciousness, given respiratory support in the intensive care unit for following 11 days. During the following period, sensory disorders involving numbness and pain, and thinning in the arms and legs were onset. At nerve conduction study, axonal polyneuropathy was identified: sensory fibers were protected, motor conduction velocities and amplitudes were extremely decreased. At needle EMG studies widespread denervation potentials were recorded to be more pronounced in the distal muscle groups. In the discussed case; a cholinergic crisis picture occurred after exposure to toxic agents in the acute phase, the patient was observed as intubated for a while, in the subacute phase a polyneuropathy mostly located in the proximal muscles was onset and muscle atrophies have emerged in the late phase. In this writing, an organophosphate intoxication case in which cholinergic crisis was set in earlier days, polyneuropathy picture was seen on subacute stage and muscle atrophies were confirmed on following weeks was discussed.

Key words: Organophosphate intoxication, cholinergic crisis, polyneuropathy

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