Chlorpyriphos induced delayed myelopathy & motor neuropathy

Introduction: Organophosphate intoxication can cause serious life threatening acute neurological complications such as seizures, paralysis, neuromuscular and cardiac conduction disorders. Less often, a predominantly motor and delayed axonal neuropathy can occur. This syndrome is due to inhibition of neuropathic target esterase. Case report: Herein we describe a 20-year-old-male patient who after ingestion of large amount of (200 ml) Chlorpyriphos based insecticide had an acute cholinergic crisis followed by development of lower limb weakness 8 weeks after initial exposure to organophosphorous. Pyramidal tract involvement was also observed as the patient developed spastic paraparesis in lower limbs. Electrophysiological study was characterized by motor axonal polyneuropathy. Conclusion: This was a case of organophosphate induced delayed neuropathy with myelopathy leading to spastic paraparesis. Hence all patients with organophosphorous poisoning should be under regular follow up and examined for neurological involvement.