Acta Scientific Neurology (ASNE) (ISSN: 2582-1121)

Case Review Volume 4 Issue 12

Head Tremor in a Patient with Organophosphorus Poisoning

Sarath Aleti1*, Kamalesh Chakravarty2, Alex Rebello1 and Sahil Mehta3

1Senior Resident, Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
2Assistant Professor, Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
3Additional Professor, Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India

*Corresponding Author: Sarath Aleti, Senior Resident, Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Received: September 27, 2021; Published: November 15, 2021

Abstract

Objectives: Organophosphorus poisoning (OPP) may rarely present with delayed neurological manifestation like Parkinsonism or coma. Neck tremor in OPP has not been reported in literature till date.

Methods: Patient presented to Emergency and was admitted in ICU and evaluated. Informed consent from patient and ethical clearance from institute has been obtained

Results: A 42 year old gentleman presented with diarrhea, sialorrhea, rhinorrhea, drowsiness and breathlessness after ingestion of organophosphorus (OP) compound for suicidal intent. He improved with decontamination, mechanical ventilation and atropine infusion. His atropine infusion was stopped. On 6th day of illness (video 1), he developed encephalopathy and a jerky movement of the neck in form of flexion and extension of the neck. His CEMRI Brain and spine and CSF were normal. EEG showed diffuse slowing. His cholinesterase levels done on day 13 were low. A possibility of OPP induced delayed encephalopathy and extra-pyramidal syndrome was considered. He was restarted on atropine infusion and he improved (video 1).

Discussion: Dystonia and tremor in neck is uncommon in OPP. A meticulous examination would prevent mistreating these patients as seizure. Pseudocholinesterase level needs to be checked to diagnose delayed manifestation of OPP. Restarting atropine infusion is the treatment.

Keywords: Head Tremor; Organophosphorus Poisoning; CNS Manifestations in Organophosphorus Poisoning; Extrapyramidal Symptoms; Encephalopathy

References

  1. Peter JV., et al. “Clinical features of organophosphate poisoning: A review of different classification systems and approaches”. Indian Journal of Critical Care Medicine11 (2014): 735-745.
  2. Singh S and Sharma N. “Neurological syndromes following organophosphate poisoning”. Neurology India4 (2000): 308-313.
  3. Peter JV., et al. “Delayed-onset encephalopathy and coma in acute organophosphate poisoning in humans”. Neurotoxicology2 (2008): 335-342.
  4. Senanayake N and Sanmuganathan PS. “Extrapyramidal manifestations complicating organophosphorus insecticide poisoning”. Human and Experimental Toxicology 7 (1995): 600-604.
  5. Müller-Vahl KR., et al. “Transient severe parkinsonism after acute organophosphate poisoning”. Journal of Neurology, Neurosurgery, and Psychiatry 66 (1999): 253-254.
  6. Reji KK., et al. “Extrapyramidal effects of acute organophosphate poisoning”. Clinical Toxicology (Phila)3 (2016): 259-265.
  7. Moody SB and Terp DK. “Dystonic Reaction Possibly Induced by Cholinesterase Inhibitor Insecticides”. Drug Intelligence4 (1988): 311-312.
  8. Hsieh BH., et al. “Acetylcholinesterase inhibition and the extrapyramidal syndrome: a review of the neurotoxicity of organophosphate”. Neurotoxicology4 (2001): 423-427.

Citation

Citation: Sarath Aleti., et al. “Head Tremor in a Patient with Organophosphorus Poisoning".Acta Scientific Neurology 4.12 (2021): 21-24.

Copyright

Copyright: © 2021 Sarath Aleti., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.




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Impact Factor1.088

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