The aim of this study is to report our experience with a child who developed extrapyramidal perturbations complicating acute
organophosphate insecticides poisoning and to review the literature reporting on basal ganglia impairment associated with this
poisoning. Our patient had developed overt
parkinsonism presenting with a
resting tremor, expressionless face, and lack of blinking along with marked
cogwheel rigidity and a stooped, slow gait. He was alert, coherent, and cooperative, yet agitated. The parkinsonian perturbations developed 5 days after an accidental ingestion of a raw eggplant sprayed with the
organophosphate dimethoate (
Rogor) when he had already recovered from the acute
cholinergic crisis, the first stage of
organophosphate poisoning. Such a presentation was initially perceived by his caregivers as severe
reactive depression or even
psychosis. Once a
parkinsonian syndrome was diagnosed, he was begun on
amantadine and completely recovered within 1 week with no relapse of symptoms. Basal ganglia impairment should be considered in any patient who develops extrapyramidal symptoms such as marked rigidity and
bradykinesia or choreoathetosis while recovering from the acute
cholinergic phase of
organophosphate insecticide poisoning. Thus, administration of a
drug such as
amantadine, which probably enhances neurotransmission, may hasten the rate of recovery and prevent long-term neurologic and emotional sequelae.