Delayed Neuropathy and Myelopathy after Organophosphate Intoxication

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Abstract
Massive organophosphorus-compound intoxication is relatively common. Although uncommon, delayed neurotoxicity may also occur in humans.1 Persons with organophosphorus-compound poisoning have acute toxic effects, with a cholinergic crisis due to inhibition of acetylcholinesterase. Some persons subsequently have organophosphate-induced delayed neuropathy, which may be related to the inhibition of neurotoxic esterase.2 Organophosphate-induced delayed neuropathy results in damage to both the peripheral and the central nervous systems.3 The exact sequence of lesions in these systems remains controversial, and few reports have discussed central nervous system neuropathological changes in humans. We describe a patient who had a classic acute cholinergic crisis after exposure to organophosphates, with the subsequent development of organophosphate-induced delayed neuropathy. Magnetic resonance imaging (MRI) showed diffuse spinal cord atrophy that persisted long after the cholinergic effects had subsided.

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