Espontánea reversibilidad de un síndrome de Parkinson tardío y de alteraciones cognitivas frontales, después de una intoxicación aguda con órganofosforados

摘要

Acute organophosphate poisoning usually produces a cholinergic crisis followed by muscular 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 cholinergic crisis 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 syndrome and 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.