Shahar Eli, Bentur Yedidia, Bar-Joseph Gad, Cahana Alfred, Hershman Eli
Child Neurology Unit, Meyer Children Hospital, Haifa, Israel.
Pediatr Neurol. 2005 Nov;33(5):378-82. doi: 10.1016/j.pediatrneurol.2005.05.016.
The aim of this study is to report our experience with a child who developed extrapyramidal perturbations complicating acute organophosphate insecticides poisoning and to review the literature reporting on basal ganglia impairment associated with this poisoning. Our patient had developed overt parkinsonism presenting with a resting tremor, expressionless face, and lack of blinking along with marked cogwheel rigidity and a stooped, slow gait. He was alert, coherent, and cooperative, yet agitated. The parkinsonian perturbations developed 5 days after an accidental ingestion of a raw eggplant sprayed with the organophosphate dimethoate (Rogor) when he had already recovered from the acute cholinergic crisis, the first stage of organophosphate poisoning. Such a presentation was initially perceived by his caregivers as severe reactive depression or even psychosis. Once a parkinsonian syndrome was diagnosed, he was begun on amantadine and completely recovered within 1 week with no relapse of symptoms. Basal ganglia impairment should be considered in any patient who develops extrapyramidal symptoms such as marked rigidity and bradykinesia or choreoathetosis while recovering from the acute cholinergic phase of organophosphate insecticide poisoning. Thus, administration of a drug such as amantadine, which probably enhances neurotransmission, may hasten the rate of recovery and prevent long-term neurologic and emotional sequelae.
本研究的目的是报告我们对一名患有锥体外系紊乱（这使急性有机磷杀虫剂中毒情况复杂化）儿童的治疗经验，并回顾有关这种中毒相关基底神经节损伤的文献报道。我们的患者出现了明显的帕金森症，表现为静止性震颤、表情淡漠、瞬目减少，同时伴有明显的齿轮样强直以及弯腰驼背、步态迟缓。他神志清醒、思维连贯且配合，但情绪激动。该帕金森症样紊乱在意外摄入喷洒了有机磷乐果的生茄子5天后出现，当时他已从急性胆碱能危象（有机磷中毒的第一阶段）中恢复。这种表现最初被其照顾者认为是严重的反应性抑郁甚至精神病。一旦诊断为帕金森综合征，即开始给予金刚烷胺治疗，患者在1周内完全康复且症状未复发。对于任何在从有机磷杀虫剂中毒的急性胆碱能阶段恢复过程中出现锥体外系症状（如明显强直、运动迟缓或舞蹈手足徐动症）的患者，都应考虑基底神经节损伤。因此，给予可能增强神经传递的药物（如金刚烷胺），可能会加快恢复速度并预防长期神经和情绪后遗症。
