title: Neurological manifestations of organophosphorous insecticide poisoning.
abstract: Neurological findings are described in 200 consecutive cases of suicidal ingestion of organophosphorous insecticides. Miosis is almost universal. We found impairment of consciousness in 10%, fasciculations in 27%, convulsions in 1%, toxic delirium in 50%, and paralysis in 26%. Toxic delirium was attributed to treatment with atropine. Paralytic signs were divided into type 1 signs (present on admission) and type 2 signs (appearing later while on atropine treatment). Type 1 signs, chiefly impaired consciousness and bilateral pyramidal tract signs, respond to atropine. The most common type 2 signs are proximal limb weakness, areflexia, and cranial nerve palsies. EMG studies during type 2 paralysis show a myasthenic response in some cases. Of 36 cases with type 2 signs 15 died from respiratory paralysis after a variable period of artificial respiration. Twenty-one recovered and no residual neurological deficit has been noted. Atropine did not influence type 2 paralysis. It is claimed that type 2 signs differ significantly from those described before as `delayed neurotoxicity' and may represent an alternative mode of human toxicity with organophosphorous compounds.
mesh_terms: D005158:Facial Paralysis / Q000139:chemically induced; D006801:Humans; D007306:Insecticides / Q000506:poisoning*; D009119:Muscle Contraction; D009135:Muscular Diseases / Q000139:chemically induced; D009461:Neurologic Manifestations; D009886:Ophthalmoplegia / Q000139:chemically induced; D009943:Organophosphorus Compounds; D010243:Paralysis / Q000139:chemically induced*; D011041:Poisoning / Q000175:diagnosis; D011605:Psychoses, Substance-Induced; D012021:Reflex, Abnormal / Q000139:chemically induced; D012133:Respiratory Paralysis / Q000139:chemically induced; D013577:Syndrome; D014474:Unconsciousness / Q000139:chemically induced
chemical_list: D007306:Insecticides; D009943:Organophosphorus Compounds