Caso Clinico
Palabras clave: Intoxicación por órganofosforados, síndrome parkinsoniano reversible, síndrome frontal reversible.
Abstract
Acute organophosphate poisoning usually produces a cholinergic crisis followed bymuscular weakness or intermediate syndrome. The basis for these clinical manifestations is inactivation of acetylcholinesterase at the nicotinic and muscarinic nerve terminals and junctions. Different mechanism might lead to polyneuropathy and late extrapyramidal syndromes. We report a case of a male patient who ingested organophosphate with suicidal intentions. He developed a typical cholinergiccrisis and required invasive mechanical ventilation. Three weeks later, frontal cognitive impairment was noticed and masklike face, generalized rigidity, bradykinesia and tremor progressively developed until a Parkinson syndrome was established. After his clinical condition had remained stable for at least two weeks, overt spontaneous improvement in motor and cognitive functions was observed.Similar reports in literature are infrequent. Although the pathophysiology that underlies extrapyramidal manifestations due organophosphate poisoning remains unclear, experimental evidence demostróte that organophosphate compounds impair dopamine transport and uptake. This case report suggests that organophosphate might act through a double pathogenic action i.e an initial acute cholinergic syndromeand a delayed disfunction in dopaminergic pathways. Complete spontaneous resolution of both effects allow us to classify organophosphate substances as a cause of functional impairment in the basal ganglia.
Key words: Organophosphate poisoning, reversible Parkinson syndrome, reversible cognitive impairment.
Introducción
El hombre ha usado pesticidas desde hace muchos siglos. Los Sumerios hace4.500 años para proteger sus cultivos usaban substancias vegetales o minerales, como insecticidas. Paul Muller en 1939 logró sintetizar el DDT y ganó el premio Nobel por este descubrimiento, que fue el gran insecticida hasta los años 60. Época en que se suspendió su uso, debido a su lenta degradación natural, que era la causa de su acumulación en plantas y tejidos animales (leche). Entonces se...
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