A Rare Neurological Complication of Acute Organophosphorous Poisoning
A 30-year-old female patient ingested an unknown dose of Triazophos 40% (Hostathion) in a suicide attempt. As per the history revealed by her parents, she had consumed the above mentioned compound 8 h prior to hospitalization. At the time of admission to the ICU, the patient was drowsy with a Glasgow Coma Scale score of 10/15 and had bilateral pinpoint pupils reactive to light, blood pressure measured 140/70 mmHg. Her pseudocholinesterase level was 869 U/l (Normal: 4852-12000 U/l). depicts other laboratory parameters. She was treated with pralidoxime 24 g infusion over 48 h and atropine 120 mg infused over 4 days. Thereafter, the patient regained consciousness, but was immobile. On day 6, neurological examination revealed that the patient had coarse resting tremors with cog-wheel rigidity and signs of dyskinesia affecting both the upper and lower limbs, more predominant on the right side. Cerebral spinal fluid analysis following a lumbar puncture was normal. Magnetic resonance imaging (MRI) showed no focal abnormality in the brain parenchyma.\nThe patient's mobility did not improve despite complete recovery from respiratory and cardiovascular distress. It was noticed that even on the 10th day, she was unable to speak and turn around on the bed. In view of the above signs, a provisional diagnosis of OP-induced Parkinsonism was made. Treatment with tablet amantadine 100 mg/day thrice daily was started orally. After receiving therapy for a day, there was marked improvement in orientation, mobility, and speech. By the 4th day of amantadine treatment, cog-wheel rigidity, tremors, and bradykinesia improved. After 14 days of treatment with the same dose of amantidine, the patient recovered completely and the therapy was discontinued. She did not develop any adverse effects to amantidine. The patient was discharged on day 26 and subsequent follow-up revealed no signs of relapse.