Diao Jiuzhou, Zhou Qingbo
Department of Neurology, The Second Hospital of Shandong University, Jinan, China.
Front Neurol. 2023 Jun 2;14:1144970. doi: 10.3389/fneur.2023.1144970. eCollection 2023.
Avermectin Pyridaben (AVP) is an insecticide with extreme neurotoxicity in human, causing critical symptoms such as nausea, vomiting, coma and respiratory failure within a short time after oral ingestion. Neurological sequelae or even death may occur because of delayed treatment or excessive toxic dose.
We report a 15-year-old girl who presented with coma, respiratory failure, limb weakness, ataxia symptoms after ingestion of a toxic dose of AVP. Soon after the poisoning, the patient was treated with life-saving mechanical ventilation and haemodialysis. Subsequently brain Magnetic Resonance Imaging (MRI) and nerve conduction study (NCS) and electromyography (EMG) demonstrated toxic encephalopathy and peripheral nerve injury. Over the next 2 months the patient's limb function gradually recovered under treatment with hyperbaric oxygen, glucocorticoid pulses and neurotrophic drugs.
This case documents a rare presentation of toxic encephalopathy complicated with peripheral neuropathy following AVP poisoning. Seven other similar cases of poisoning in terms of common symptoms and effective treatment have also been summarised for providing clinicians with experience in diagnosis and therapy.
阿维菌素哒螨灵（AVP）是一种对人类具有极高神经毒性的杀虫剂，口服摄入后短时间内会引发恶心、呕吐、昏迷和呼吸衰竭等严重症状。由于治疗延迟或中毒剂量过大，可能会出现神经后遗症甚至死亡。
我们报告一名15岁女孩，在摄入中毒剂量的AVP后出现昏迷、呼吸衰竭、肢体无力和共济失调症状。中毒后不久，患者接受了挽救生命的机械通气和血液透析治疗。随后，脑部磁共振成像（MRI）、神经传导研究（NCS）和肌电图（EMG）显示存在中毒性脑病和周围神经损伤。在接下来的2个月里，患者在高压氧、糖皮质激素脉冲和神经营养药物治疗下，肢体功能逐渐恢复。
本病例记录了AVP中毒后罕见的中毒性脑病合并周围神经病变表现。还总结了其他7例具有相似症状和有效治疗方法的中毒病例，为临床医生提供诊断和治疗经验。
