Opsoclonus and lingual myoclonus due to organophosphate poisoning: images in clinical medicine

Rajasekharan, Chandrasekharan; Renjith, Sanu Watson; Jayapal, Thampi

doi:10.1136/bcr-2012-007043

Cited by 6 publications

(9 citation statements)

References 2 publications

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“…The patient developed a considerable number of neuromuscular complications after 1 year. Rajasekharan et al 23 reported an Indian case of opsoclonus and lingual myoclonus after chlorpyrifos intoxication. Moreover, Thivakaran et al 24 demonstrated a case of chlorpyrifos-induced delayed myelopathy and pure motor neuropathy in a 15-year-old Sri Lanka female.…”

Section: Resultsmentioning

confidence: 99%

Outcome of patients with chlorpyrifos intoxication

et al. 2020

Hum Exp Toxicol

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Introduction: There is a paucity of literature analyzing outcome of chlorpyrifos intoxication. Methods: A total of 40 patients with chlorpyrifos intoxication were seen at Chang Gung Memorial Hospital between 2008 and 2017. Patients were stratified into two subgroups according to their prognosis, as good ( n = 12) or poor ( n = 28). Good prognosis group were defined as patients who survived without serious complications, and poor prognosis group included patients who died and survived after development of severe complications. Demographic, clinical, laboratory, and mortality data were obtained for analysis. Results: Patients aged 53.8 ± 16.3 years and most were male (80.0%). All patients (100.0%) developed acute cholinergic crisis such as emesis (45.0%), respiratory failure (42.5%), tachycardia (30.0%), kidney injury (22.5%), and seizure (7.5%). Intermediate syndrome developed in 12.5% of patients, but none had delayed neuropathy (0%). The poor prognosis group suffered higher incidences of respiratory failure ( p = 0.011), kidney injury ( p = 0.026), and prolonged corrected QT interval ( p = 0.000), and they had higher blood urea nitrogen level ( p = 0.041), lower Glasgow coma scale score ( p = 0.011), and lower monocyte count ( p = 0.023) than good prognosis group. All patients were treated with atropine and pralidoxime therapy, but six patients (15.0%) still died of intoxication. In a multivariate logistic regression model, blood urea nitrogen was a significant risk factor for poor prognosis (odds ratio: 1.375, 95% confidence interval: 1.001–1.889, p = 0.049). Nevertheless, no mortality risk factor could be identified. Conclusion: The mortality rate of patients with chlorpyrifos intoxication was 15.0%. Furthermore, acute cholinergic crisis, intermediate syndrome, and delayed neuropathy developed in 100.0%, 12.5%, and 0% of patients, respectively.

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Section: Resultsmentioning

confidence: 99%

Outcome of patients with chlorpyrifos intoxication

et al. 2020

Hum Exp Toxicol

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“…Lingual myoclonus is the uncontrolled repetitive and rhythmic jerks of the tongue in semiconscious or unconscious patients. It is uncommonly seen in the late complications of the intermediate syndrome following OP exposure management [7]. The precise etiology for the necrosis in this case could not be established.…”

Section: Discussionmentioning

confidence: 78%

“…Inadequate atropinization may lead to higher rates of aspiration pneumonia and death [10]. OP poisoning is associated with rare complications such as acute pancreatitis, opsoclonus, lingual myoclonus and necrosis of tongue [7][8][9]. Circulatory disturbances and necrosis of the tongue are extremely rare because of its rich vascularity.…”

Section: Discussionmentioning

confidence: 99%

“…Identification of the respiratory failure, early endotracheal intubation and immediate pharmacological management are required for successful management. Development of delayed or rare complications such as toxic pancreatitis, opsoclonus and lingual myoclonus are reported in the literature [7,8]. Necrosis of tongue is a rare complication following OP poisoning that is reported in a single case report, although the precise etiology remains unknown [9].…”

Section: Introductionmentioning

confidence: 99%

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Necrosis of Tongue: A Sequela of Complications in Organophosphate Poisoning

Irfan¹,

Sanadi²

2020

JSCR

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Organophosphate compounds are mainly used in the agriculture and domestic pesticides. The widespread availability of these pesticides results in the inadvertent usage leading to the main agent used in suicide attempts in the developing countries. The severity of the poisoning greatly depends on the type of exposure, quantity and the product. They can cause life threatening complications mainly by the respiratory depression leading to coma and death. Early identification and appropriate management enable to reduce the morbidity and mortality. Atropine, oximes, intravenous fluids are administered for the successful management. A detailed medline search of the associated complications, although rare, necrosis of tongue is reported in only one case associated with organophosphate poisoning. The etiological factors were not mentioned in the found literature. In this case report, we discuss the sequela of complications associated with the acute poisoning cases and the role of maxillofacial surgeons in the management.

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“…Organophosphates (OPPs) [26][27][28] Organophosphate is a group of approximately 40 pesticides that kill insects and other animals by impacting the function of central and peripheral nervous system by inhibiting the activity of acetylcholinesterase (AChE) [29].…”

Section: Chlordecone [17-20]mentioning

confidence: 99%

Drug- and Toxin-Induced Opsoclonus – a Systematized Review, including a Case Report on Amantadine-Induced Opsoclonus in Multiple System Atrophy

Cannilla,

Messe,

Girardin

et al. 2024

Tremor and Other Hyperkinetic Movements

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Background: Opsoclonus is a rare disorder characterized by conjugate multidirectional, horizontal, vertical, and torsional saccadic oscillations, without intersaccadic interval, resulting from dysfunction within complex neuronal pathways in the brainstem and cerebellum. While most cases of opsoclonus are associated with autoimmune or paraneoplastic disorders, infectious agents, trauma, or remain idiopathic, opsoclonus can also be caused by medications affecting neurotransmission. This review was prompted by a case of opsoclonus occurring in a patient with Multiple System Atrophy, where amantadine, an NMDA-receptor antagonist, appeared to induce opsoclonus.Methods: Case report of a single patient and systematized review of toxic/drug-induced opsoclonus, selecting articles based on predefined criteria and assessing the quality of included studies. Results:The review included 30 articles encompassing 158 cases of toxic/drug-induced opsoclonus. 74% of cases were attributed to bark scorpion poisoning, followed by 9% of cases associated with chlordecone intoxication. The remaining cases were due to various toxics/drugs, highlighting the involvement of various neurotransmitters, including acetylcholine, glutamate, GABA, dopamine, glycine, and sodium channels, in the development of opsoclonus. Conclusion:Toxic/drug-induced opsoclonus is very rare. The diversity of toxics/drugs impacting different neurotransmitter systems makes it challenging to define a unifying mechanism, given the intricate neuronal pathways underlying eye movement physiology and opsoclonus pathophysiology.

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Opsoclonus and lingual myoclonus due to organophosphate poisoning: images in clinical medicine

Cited by 6 publications

References 2 publications

Outcome of patients with chlorpyrifos intoxication

Outcome of patients with chlorpyrifos intoxication

Necrosis of Tongue: A Sequela of Complications in Organophosphate Poisoning

Drug- and Toxin-Induced Opsoclonus – a Systematized Review, including a Case Report on Amantadine-Induced Opsoclonus in Multiple System Atrophy

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