1/3. Extra-pyramidal parkinsonism complicating organophosphate insecticide poisoning.We present a 1 7-year-old female with acute extra-pyramidal parkinsonism complicating a suicidal attempt with the organophosphate insecticide chlorpyrifos, who was initially suspected to have developed severe depression or psychosis. On admission she was stupurous, with diarrhoea and massive salivation lapsing into respiratory failure and coma. Following atropine and toxogonin treatment along with mechanical ventilation she developed overt extrapyramidal parkinsonism and encephalopathy, characterized by impaired sensorium and agitation, mask facies along with a muffled voice and swallowing impairment, a resting tremor with cogwheel rigidity switching to bradykinetic choreoathetotic movements. Once a parkinsonian syndrome was diagnosed, she was given amantadine therapy with complete recovery. The patient is presently maintained on amantadine therapy; there was mild worsening of her extrapyramidal signs following unplanned discontinuation of this medication, and on follow-up assessments after 9 months she is virtually asymptomatic. A parkinsonian extrapyramidal syndrome, complicating organophosphate intoxication, should therefore also be taken into account in any patient with organophosphate poisoning, presenting with marked behavioural alterations, rigidity or akinetic mutism, and beneficial response to amantadine.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
2/3. A case of Parkinsonism due to lithium intoxication: treatment with Pramipexole.We report the case of a 72-year-old woman with bipolar disorder treated with lithium for over a year, who suddenly developed disabling Parkinsonism, apparently after a gastroenteric infection. On hospital admission lithium plasma levels were 3.7 mmol/l. After lithium discontinuation, plasma levels decreased to 0.7 mmol/l, but without resolution of neurological symptoms. Biperidene and levodopa-benserazide did not ameliorate her extrapyramidal symptoms. Pramipexole 0.25 mg TID improved dramatically the Parkinsonism and all neurological symptoms resolved in a few days.- - - - - - - - - - ranking = 4keywords = intoxication (Clic here for more details about this article) |
3/3. Effective treatment of manganese-induced occupational Parkinsonism with p-aminosalicylic acid: a case of 17-year follow-up study.OBJECTIVE: Chronic manganese (Mn) intoxication induces syndromes resembling parkinson disease. The clinical intervention has largely been unsuccessful. We report a 17-year follow-up study of effective treatment of occupational Mn parkinsonism with sodium para-aminosalicylic acid (PAS). methods: The patient, female and aged 50 at the time of treatment, was exposed to airborne Mn for 21 years (1963-1984). The patient had palpitations, hand tremor, lower limb myalgia, hypermyotonia, and a distinct festinating gait. She received 6 g PAS per day through an intravenous drip infusion for 4 days and rested for 3 days as one therapeutic course. Fifteen such courses were carried out between March and June 1987. RESULTS: At the end of PAS treatment, her symptoms were significantly alleviated, and handwriting recovered to normal. Recent follow-up examination at age 67 years (in 2004) showed a general normal presentation in clinical, neurologic, brain magnetic resonance imaging, and handwriting examinations with a minor yet passable gait. CONCLUSIONS: This case study suggests that PAS appears to be an effective drug for treatment of severe chronic Mn poisoning with a promising prognosis.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |