Acute encephalopathy followed by delayed myelopathy: A rare presentation of organophosphate poisoning

Organophosphorus compounds (OPC) are commonly used pesticides and suicidal ingestion is a common mode of poisoning. The manifestation of OPC poisoning and its severity depend upon the type, dose and potency of the OPC consumed. Neurological presentations are well defined clinical syndromes consisting of early, intermediate and delayed manifestations (rare), categorised on the basis of time elapsed since OPC exposure. We report a rare delayed manifestation of organophosphorus poisoning in the form of pure motor spastic paraparesis due to dorsal myelopathy. A possibility of delayed manifestations of toxicity should be considered in individuals presenting with features suggestive of myelopathy and a previous history of organophosphate exposure.

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Coronary Artery Bypass Grafting in a Patient with Organophosphate Poisoning

The Heart Surgery Forum ◽

10.1532/hsf.1370 ◽

2015 ◽

Vol 18 (4) ◽

pp. 167 ◽

Cited By ~ 1

Author(s):

Rajeeva R. Pieris ◽

Ravindra Fernando

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Previous History ◽

Organophosphate Poisoning ◽

Bypass Grafting ◽

Artery Bypass Grafting ◽

Excellent Health ◽

History Of

A 43-year-old male, with no previous history of mental illness, was diagnosed with coronary heart disease, after which he became acutely depressed and attempted suicide by ingesting an organophosphate pesticide. He was admitted to an intensive care unit and treated with pralidoxime, atropine, and oxygen. His coronary occlusion pattern required early coronary artery bypass grafting (CABG) surgery. His family, apprehensive of a repeat suicidal attempt, requested surgery be performed as soon as possible. He recovered well from the OP poisoning and was mentally fit to express informed consent 2 weeks after admission. Seventeen days after poisoning, he underwent coronary artery bypass grafting and recovered uneventfully. Six years later, he remains in excellent health. We report this case because to the best of our knowledge there is no literature regarding CABG performed soon after organophosphate poisoning.

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Ocular non-teratoid medulloepithelioma with teratoid metastases in ipsilateral intraparotid lymph nodes

European Journal of Ophthalmology ◽

10.1177/1120672119870079 ◽

2019 ◽

pp. 112067211987007

Author(s):

Jayati Sarangi ◽

Aanchal Kakkar ◽

Diya Roy ◽

Rishikesh Thakur ◽

Chirom Amit Singh ◽

...

Keyword(s):

Lymph Nodes ◽

Histopathological Examination ◽

Previous History ◽

Rare Presentation ◽

Cervical Lymph Nodes ◽

Extranodal Extension ◽

Positron Emission ◽

Parotid Neoplasm ◽

History Of ◽

The Right

Purpose: To describe a rare presentation of a case of intraocular non-teratoid medulloepithelioma with teratoid metastases in ipsilateral intraparotid lymph nodes. Case description: A 9-year-old male child with previous history of ciliary body non-teratoid medulloepithelioma presented with a swelling in the right pre-auricular region for 1 month. Magnetic resonance imaging and positron emission tomography–computed tomography showed a right intraparotid mass with enlarged ipsilateral cervical lymph nodes. A core biopsy was taken from the lesion, which on microscopy showed a tumor composed of small round cells arranged in cords, tubules lined by multilayered cells, and in cribriform pattern. These cells were embedded in a hypocellular, loose myxoid matrix. Based on the histopathological characteristics and previous history, a diagnosis of medulloepithelioma metastastic to ipsilateral parotid gland was made. The patient underwent right total conservative parotidectomy and bilateral neck dissection. Histopathological examination revealed metastatic medulloepithelioma in five out of eight intraparotid lymph nodes, with extranodal extension into the adjacent parotid parenchyma. Foci of hyaline cartilage were identified within the tumor, leading to a diagnosis of metastatic teratoid medulloepithelioma. Conclusion: Intraparotid lymph node metastases from intraocular medulloepithelioma is a rare possibility and we recommend that the parotid should be evaluated in cases of intraocular medulloepithelioma at initial presentation as well as during the follow-up period. Also, metastasis should be considered in all pediatric patients with solitary mass lesions showing unconventional histology for a primary parotid neoplasm.

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Acute encephalopathy followed by delayed myelopathy a rare presentation of chlorpyriphos (organophosphorus) poisoning

Journal of the Neurological Sciences ◽

10.1016/j.jns.2019.10.1181 ◽

2019 ◽

Vol 405 ◽

pp. 206

Author(s):

A. Agarwal ◽

V. Goyal ◽

V. Vy ◽

M. Singh Bhushan ◽

A. Garg ◽

...

Keyword(s):

Acute Encephalopathy ◽

Rare Presentation ◽

Organophosphorus Poisoning

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Recognizing Aphemia and How to Differentiate From Aphasia in the Era of Telemedicine

The Neurohospitalist ◽

10.1177/1941874421990546 ◽

2021 ◽

pp. 194187442199054

Author(s):

Brittany M. Kasturiarachi ◽

Balaji Krishnaiah

Keyword(s):

Clinical Skill ◽

Precentral Gyrus ◽

Case Presentation ◽

Her Family ◽

Clinical Syndromes ◽

History Of ◽

Intimate Knowledge ◽

Pars Opercularis ◽

Pure Motor

Background: Aphemia, or pure motor mutism, is a phenomenon that has been reported previously in the literature and typically is associated with small infarcts in the inferior dominant precentral gyrus, pars opercularis, or inferior perirolandic gyrus. Clinically, it is important to distinguish aphemia from aphasia syndromes. Telemedicine is becoming more prevalent and involving neurologists across the country. This is an important consideration when addressing aphemic patients as many mistakes can be made during a virtual exam clouding a patient’s clinical picture. Case Presentation: Our patient is a 61-year-old female with a past medical history of hypertension, diabetes, and an old right frontoparietal stroke without any residual deficits. She presented after her family stated that she “quit speaking” for about seven hours. Initial neurological evaluation was done via telemedicine due to the COVID-19 pandemic and was pertinent for decreased consciousness, inability to answer either orientation question, a right facial droop, and aphasia. Later it was found that the patient exhibited a pure motor mutism rather than aphasia and had an MRI lesion in the left inferior precentral gyrus. Conclusion: Differentiating aphemia from aphasia is an important clinical skill for a neurologist to foster especially in the era of telemedicine. An intimate knowledge of the parts of a speech exam are vital in directing emergency staff during stroke evaluation. Additionally, distinguishing these clinical syndromes has implications with respect to prognosis and long-term rehabilitation.

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Visual agnosia and prosopagnosia secondary to melanoma metástases: Case report

Dementia & Neuropsychologia ◽

10.1590/s1980-57642008dn10100016 ◽

2007 ◽

Vol 1 (1) ◽

pp. 104-107 ◽

Cited By ~ 2

Author(s):

Norberto Anízio Ferreira Frota ◽

Lécio Figueira Pinto ◽

Claudia Sellitto Porto ◽

Paulo Henrique Pires de Aguia ◽

Luiz Henrique Martins Castro ◽

...

Keyword(s):

Previous History ◽

Metastatic Malignant Melanoma ◽

Partial Recovery ◽

Visual Agnosia ◽

Blurred Vision ◽

Rare Presentation ◽

Metastatic Lesions ◽

Melanoma Metastases ◽

History Of

Abstract The association of visual agnosia and prosopagnosia with cerebral metastasis is very rare. The presence of symmetric and bilateral cerebral metastases of melanoma is also uncommon. We report the case of a 34 year-old man who was admitted to hospital with seizures and a three-month history of headache, with blurred vision during the past month. A previous history of melanoma resection was obtained. CT of the skull showed bilateral heterogeneous hypodense lesions in the occipito-temporal regions, with a ring pattern of contrast enhancement. Surgical resection of both metastatic lesions was performed after which the patient developed visual agnosia and prosopagnosia. On follow-up, he showed partial recovery of visual agnosia, while prosopagnosia was still evident. The relevance of this case is the rare presentation of metastatic malignant melanoma affecting homologous occipito-temporal areas associated with prosopagnosia and associative visual agnosia.

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Clinical report. Primary granulocytic sarcoma: a rare presentation of an ovarian mass

Asian Biomedicine ◽

10.5372/1905-7415.0803.310 ◽

2014 ◽

Vol 8 (3) ◽

pp. 425-428

Author(s):

Supat Chamnanchanunt ◽

Chajchawan Nakhakes ◽

Pravinwan Thungthong ◽

Tawatchai Suwanban ◽

Kunapa Iam-arunthai ◽

...

Keyword(s):

Complete Remission ◽

Case Reports ◽

Previous History ◽

Granulocytic Sarcoma ◽

Leukemic Cells ◽

Clinical Report ◽

Ovarian Mass ◽

Rare Presentation ◽

Appropriate Treatment ◽

History Of

Abstract Background: Primary granulocytic sarcoma (GS) only rarely presents with an ovarian mass classified as extramedullary myeloid progenitor tumor cells. Few patients with cases of primary GS survive after systemic chemotherapy. Objective: To present a case of primary GS treated with complete course of chemotherapy. The patient is currently in complete remission. Methods: Retrospective review of medical records and comparison with previous case reports. Results: A 41-year-old woman presented with an ovarian mass of 6 months duration. There was no previous history of hematologic disease or presence of leukemic cells in other organs at the time of diagnosis. Immunohistochemistry confirmed the diagnosis. She received complete course of chemotherapy, after which complete remission was achieved. Conclusion: A case of primary granulocytic sarcoma of the ovary was successfully treated with chemotherapy. This disease needs careful diagnosis and appropriate treatment for a good outcome.

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A prospective evaluation of correlation between cholinesterase level and severity of organophosphorus poisoning

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20200079 ◽

2020 ◽

Vol 7 (2) ◽

pp. 276

Author(s):

M. Deepak Phanindra ◽

P. V. V. Satyanarayana ◽

Anand Acharya

Keyword(s):

Severity Score ◽

Standard Treatment ◽

Organophosphorus Compounds ◽

Treatment Protocol ◽

Serum Cholinesterase ◽

Inclusion Criteria ◽

High Severity ◽

Organophosphorus Poisoning ◽

History Of ◽

High Severity Score

Background: Organophosphorus compounds are anticholinesterases by inhibiting cholinesterase it protects acetyl chorine from hydrolysis. So, acetylcholine accumulates at the synapses, and all the clinical manifestation are due to that. So, this study has been designed to establish the reactive between level of serum and prognosis of op poisoning patients.Methods: Patient with history of organophosphorus poisoning admitted into the emergency department with following exclusion and inclusion criteria were included in this study. All patients were managed as per standard treatment protocol of op poisoning. Various parameters like demography of the patients, sign and symptoms, severity of intoxication, clinical and lab parameter manoring, Serum cholinesterase was measured every alternate day.Results: 22(47.84%) patients have mild symptom out of that 20 patient’s serum cholinesterase was more than 2000 IU/L, and 2(4.3%) patients serum cholinesterase was between 1000-2000 IU/L. In eighteen patient’s severity as per POP scale was moderate, out of that 2(4.3%) patients have serum cholinesterase was below 1000 IU/L, 8 having serum cholinesterase between 1000 to 2000 IU/L, and remaining eight having serum cholinesterase above 2000 IU/L.Conclusions: Serum cholinesterase was less in patient with high severity score or low serum concentration of cholinesterase was associated with high severity score. Serum cholinesterase was improved as days passes.

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Pattern of Organophosphorous Poisoning: A Retrospective Community Based Study

Kathmandu University Medical Journal ◽

10.3126/kumj.v9i2.6284 ◽

2012 ◽

Vol 9 (2) ◽

pp. 31-34 ◽

Cited By ~ 1

Author(s):

J Chataut ◽

R K Adhikari ◽

N P Sinha ◽

S B Marahatta

Keyword(s):

Risk Factors ◽

Organophosphorus Compounds ◽

Public Health Problem ◽

Positive Association ◽

Risk Groups ◽

Easy Access ◽

Organophosphate Poisoning ◽

Major Public Health Problem ◽

Community Based ◽

Organophosphorus Poisoning

Background Pesticide poisoning is very common in Nepal. Hospital based studies from various parts of Nepal have shown that poisoning with organophosphorus compounds is the most common type of poisoning. Current study is undertaken to see the pattern of organophosphorus poisoning and to identify the common risk factors among the cases. If the risk factors are modifiable, attempts in addressing the risk factors and decreasing the likelihood of poisoning will certainly be fruitful in reducing the morbidity and mortality associated with organophosphorus poisoning. Objectives To assess the risk factors of organophosphorus poisoning which is major public health problem in Nepal. Methods A community based retrospective study of 75 cases of organophosphate poisoning who were brought to the emergency department of Dhulikhel hospital over the period of 3 years. Basic information was collected from hospital records and home visits were made to study the risk factors. Data were collected through interviews of the study population and their family members using a pre-designed questionnaire. Results In this study 75 cases and their families were interviewed of which there were 59% males and 42% females (M/F ratio of 1:1.4). The majority (40%) of the poisoning cases were in the age group 25-34 years. Lower literacy level showed positive association with the incidence of poisoning. Occupation wise vast majority (80%) of the cases were engaged in agricultural work. Suicidal attempts by ingesting organophosphate compounds were high in farmers and females. Conclusion In this study, majority of the poisoning were attempts of intentional self harm. Agriculture workers and females are high risk groups and may be associated with the fact that they have easy access to the poison. Interventions directed towards health education, counseling, and enforcement of laws restricting the availability and use of harmful pesticides may help in reducing such events in future. DOI: http://dx.doi.org/10.3126/kumj.v9i2.6284Kathmandu Univ Med J 2011;9(2):31-4

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