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Delayed myelopathy after organophosphate intoxication: A case report
Sandesh Gautam1, Sanjaya Sapkota1, Rajeev Ojha2
1Department of Internal Medicine, Tribhuvan University Institute of Medicine, Kathmandu, Nepal.
SAGE Open Medical Case Reports
|June 24, 2022
Summary
Organophosphate-induced delayed neuropathy can manifest as myelopathy six weeks after exposure. Early identification of organophosphate exposure is crucial for diagnosing myelopathy and peripheral neuropathy.
Area of Science:
- Neuroscience
- Toxicology
- Neurology
Background:
- Organophosphate-induced delayed neuropathy (OPIDN) is a neurotoxic disorder characterized by central-distal axonopathy.
- OPIDN typically progresses through distinct phases: latent, progressive, static, and improvement.
Observation:
- A 16-year-old male presented with myelopathy six weeks post-chlorpyrifos poisoning.
- Clinical examination revealed motor weakness in lower limbs, spasticity, and exaggerated reflexes.
- Initial diagnostic tests including blood, cerebrospinal fluid, and nerve conduction studies were normal.
Findings:
- Magnetic resonance imaging (MRI) of the spine demonstrated cord atrophy.
- Physiotherapy led to significant improvement in motor power and spasticity within three months.
- This case highlights that OPIDN can present with myelopathic features as early as six weeks after exposure.
Implications:
- The improvement phase of OPIDN can unmask spinal cord lesions, mimicking myelopathy.
- A history of organophosphate exposure is critical for diagnosing myelopathy or peripheral neuropathy.
- This case underscores the importance of considering OPIDN in patients with unexplained myelopathy, especially after known exposure.
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