Rafai M A, Boulaajaj F Z, Bourezgui M, Charra B, Otmani H E, Benslama A, Motaouakkil S, Slassi I
Service de neurologie-explorations fonctionnelles, CHU d'Ibn Rochd, quartier des hôpitaux, Casablanca, Maroc.
Neurophysiol Clin. 2007 Jan-Mar;37(1):35-9. doi: 10.1016/j.neucli.2007.01.006. Epub 2007 Feb 9.
Acute organophosphate (OP) intoxications, accidental or voluntary, are responsible for a high mortality. They cause extensive muscular paralysis by acetyl cholinesterase activity inhibition at the neuromuscular junction level.
To underline the rarity and the characteristic electrophysiological pattern during cholinergic crisis.
A 28-year-old woman was admitted to the medical intensive care unit for Malathion acute intoxication with signs of glandular hypersecretion, complicated tetraparesis, and respiratory distress. The cholinesterase activity was 17%. The electroneuromyography showed multiple motor responses to the same stimulation, which is characteristic of the cholinergic crisis. Other electrophysiological parameters, in particular low-frequency repetitive stimulations, were normal. The evolution was favourable after symptomatic treatment and respiratory assistance.
Organophosphate intoxications evolve in three phases: acute cholinergic crisis, intermediate syndrome, and delayed neuropathy. While the electrophysiological aspects of delayed neuropathy are best characterized, those of crisis and intermediate syndrome remain very little studied. The persistence of acetylcholine in the synaptic slit would explain the multiple motor responses to single stimulation during the crisis.
急性有机磷中毒，无论是意外还是故意的，都导致高死亡率。它们通过抑制神经肌肉接头处的乙酰胆碱酯酶活性，引起广泛的肌肉麻痹。
强调胆碱能危象的罕见性及其特征性电生理模式。
一名28岁女性因马拉硫磷急性中毒入住医疗重症监护病房，伴有腺体分泌亢进、复杂性四肢轻瘫和呼吸窘迫症状。胆碱酯酶活性为17%。神经肌电图显示对同一刺激有多个运动反应，这是胆碱能危象的特征。其他电生理参数，特别是低频重复刺激，均正常。经对症治疗和呼吸支持后病情好转。
有机磷中毒分为三个阶段：急性胆碱能危象、中间综合征和迟发性神经病。虽然迟发性神经病的电生理特征已得到充分描述，但危象和中间综合征的电生理特征仍鲜为人知。突触间隙中乙酰胆碱的持续存在可以解释危象期间对单次刺激的多个运动反应。
