Novi uvidi u intermedijarni sindrom uzrokovan trovanjem organofosfatnim pesticidom

Acute organophosphate (OP) poisoning can be deadlier than any other type of chemical poisoning. So far, only a few cases have been described that include extensive neurological complications. We present an outstanding case of severe oral OP poisoning with intermediate syndrome developed on the fourth day after hospital admission. The clinical picture involved weakness of the proximal upper and lower limb muscles and several muscles supplied by motor cranial nerves, but, what is peculiar, the distal upper and lower limb muscles were also affected (forearms, hands, legs, and feet). To our knowledge, this is a unique presentation, as lower limb muscle weakness was reported only in the context of delayed polyneuropathy. Another remarkable feature was the involvement of six of the twelve cranial nerves, which makes this case of intermediate syndrome the first with such a spread of muscle weakness and provides new insights into the polymorphic clinical manifestations of acute OP poisoning.Akutno trovanje organofosfatima (OP) može biti smrtonosnije od bilo koje druge vrste trovanja kemikalijama. Dosada je opisano tek nekoliko slučajeva s neurološkim komplikacijama širokih razmjera. Ovdje donosimo prikaz jednog iznimnno teškog slučaja trovanja pacijentice diazinonom, u koje se intermedijarni sindrom javio četvrtoga dana hospitalizacije. Njezina klinička slika obuhvaćala je slabost u pojedinim mišićima proksimalnih dijelova gornjih udova povezanih s motornim kranijalnim živcima, ali ono što je neobično bila je slabost mišića u distalnim dijelovima donjih udova. Koliko znamo, to je jedinstven takav slučaj, s obzirom na to da je slabost u mišićima donjih udova opisana samo u kontekstu kasne polineuropatije. Uz to, ovaj se slučaj intermedijarnog sindroma ističe i dosad nezabilježenom zahvaćenošću šest od dvanaest kranijalnih živaca. Time je dobiven novi uvid u polimorfnu narav kliničkih manifestacija akutnog trovanja organofosfatima