Delayed neuropathy after organophosphorus insecticide (Dipterex) poisoning: a clinical, electrophysiological and nerve biopsy study.

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Abstract
Clinical, electrophysiological and histological findings in 4 patients accidentally poisoned with the organophosphorus insecticide Dipterex were reported. Three-5 wk after insecticide ingestion signs of a distal sensorimotor (preponderantly motor) neuropathy occurred. The patients complained of paraesthesia in the lower limbs, and 2 had disagreeable pricking sensation in the soles of the feet, responsive to carbamazepine. They showed distal weakness mainly of the legs, footdrop, difficult gait and muscle hypotonia. Ankle jerk was abolished while other tendon reflexes persisted. Two mo. or later after poisoning, knee jerks in all the patients were brisk and more and less accompanied by other pyramidal signs (patellar clonus, abolishment of abdominal cutaneous reflexes, Babinski''s sign). Clinical, electrophysiological and nerve biopsy data revealed a dying-back neuropathy. Distal muscle fatigue was confirmed by failure of neuromuscular transmission on repetitive nerve stimulation.