SHM Converge Scientific Abstract ePoster Gallery-Chronic Occupational Exposure to Organophosphate With Evolving Basal Ganglia Pathology

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This case report describes a 57-year-old Hispanic man who worked as a pest control technician with 7 years of occupational organophosphate exposure. He presented after syncope at work and had a 6-month history of frequent falls, resting tremor, slurred speech, and ataxic gait. He denied exposure to alcohol, drugs, or other toxins.<br /><br />Initial CT of the head showed enlargement and edema of the bilateral basal ganglia without hemorrhage. Brain MRI demonstrated bilateral basal ganglia edema and abnormal signal extending into the cerebral peduncle, with restricted diffusion in the medial globus pallidus suggestive of necrosis. CSF studies were unrevealing and helped exclude infectious, autoimmune, and paraneoplastic causes. After multidisciplinary review with Neurology and Radiology, his findings were attributed to chronic organophosphate exposure causing bilateral basal ganglia injury.<br /><br />During hospitalization, the patient improved with supportive care and cessation of exposure. He was discharged with instructions to avoid organophosphates permanently.<br /><br />The report highlights that while acute organophosphate poisoning typically presents with muscarinic and nicotinic symptoms, chronic exposure may present more subtly, often without classic cholinergic features, and can be misdiagnosed. Neurologic manifestations may include tremor, ataxia, dysarthria, and parkinsonian features related to basal ganglia involvement. The authors emphasize the importance of taking a careful occupational history, considering toxic exposures in unexplained neurologic syndromes, and collaborating across specialties. Symptom improvement may occur when further exposure is stopped, making early recognition crucial.

Asset Subtitle

Angelin Raju

Meta Tag

Author List Aashish Anunaya, Aashritha Hemmige, Angelin Raju, Kamran Chaudhry, Martin Marinov

Category Clinical Vignettes

Concept Organophosphate Poisoning

Concept Delayed Neuropathy

Concept Neurologic Symptoms

Concept Basal Ganglia Injury

Concept Occupational Exposure History

Distinguished Non-Finalist

Presenter Organization Texas Health Resources Heb/Denton

Presenting Author Angelin Raju

Track Adult

Keywords

organophosphate exposure

basal ganglia injury

syncope

ataxic gait

resting tremor

dysarthria

parkinsonian features

occupational toxicity

brain MRI

chronic poisoning

Organophosphate Poisoning

Delayed Neuropathy

Neurologic Symptoms

Basal Ganglia Injury

Occupational Exposure History