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Pontine myelinolysis in a child with carbamate poisoning

Raffaele Santinelli1, Carlo Tolone, Angelo D'Avanzo

  • 1Department of Pediatrics, Second University of Naples, Italy.

Clinical Toxicology (Philadelphia, Pa.)
|June 6, 2006
PubMed

Insights

Carbamate pesticide poisoning in a child caused central pontine myelinolysis, a rare demyelinating condition. This neurological damage, identified via MRI, eventually resolved over two years.

Area of Science:

  • Neuroscience
  • Toxicology
  • Pediatrics

Background:

  • Carbamate and organophosphate pesticides are common neurotoxins.
  • Pesticide poisoning can lead to immediate and delayed neurotoxic effects.

Observation:

  • A 4-year-old boy presented with stupor, lethargy, hypotonia, weakness, ataxia, miosis, and excessive salivation.
  • Carbaryl (1-naphthyl-N-methylcarbamate) was detected in the patient's blood and urine.
  • Magnetic resonance imaging (MRI) revealed central pontine myelinolysis on day 11.

Findings:

  • Central pontine myelinolysis, a demyelinating condition, was diagnosed in a child following carbamate pesticide poisoning.
  • The demyelination observed via MRI showed improvement after 4 months and complete resolution after 2 years.

Implications:

  • This case highlights a previously undescribed association between carbamate poisoning and central pontine myelinolysis in children.
  • It underscores the potential for delayed neurotoxic effects from pesticide exposure, necessitating thorough diagnostic evaluation.

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