Neurophysiology of Acute Quadriparesis

Acute respiratory failure is a life-threatening emergency requiring intensive care. Nerve conduction and repetitive nerve stimulation studies are invaluable to solve dilemmas related to the diagnosis and management. The results of these tests are available immediately, and prompt treatment can be given as illustrated in this case.

A 7-year-old boy presented in circulatory shock and impending respiratory failure to the casualty without any preceding illness.

The clinical picture, blood reports, and neurophysiological findings of repetitive compound muscle potentials on nerve conduction and a progressive decremental pattern on repetitive nerve stimulation were suggestive of acute organophosphate poisoning. This led to prompt institution of appropriate treatment comprising Ryle's tube aspiration, respiratory support, and administration of neostigmine and pralidoxime. The diagnosis was later confirmed by low serum pseudocholinesterase levels.

This case exemplifies the importance of neurophysiological study in the diagnosis of organophosphate poisoning.