Organophosphate induced Delayed Myeloneuropathy

Organophosphorus compounds are common insecticidal agents used in India. Their use as a suicidal agent is also well known often leading to massive organophosphorus-compound intoxication. Although uncommon, delayed neurotoxicity has been consistently reported in literature probably related to the inhibition of neurotoxic esterase. This mechanism is implicated not only in damaging peripheral nervous sytem but also in causing central processes leading to Myelopathy. We describe a patient who had a classic acute cholinergic crisis after exposure to organophosphates, with the subsequent development of organophosphateinduced delayed neuropathy. Magnetic resonance imaging (MRI) showed diffuse spinal cord atrophy that persisted long after the cholinergic effects had subsided.