Abstract
Organofosfat zehirlenmeli (OFZ) olgularda sıklıkla parasempatik sinir sisteminin aşırı aktivi-tesine bağlı bulgular meydana gelmektedir. Ancak bazen hipertansiyon ve taşikardi gibi sempatik sinir sisteminin aşırı aktivitesi ile ilişkili bulgular da gelişebilir. Subaraknoid kanamalar (SAK) sıklıkla anevrizma veya arteriovenöz malformasyonun (AVM) rüptürüne sekonder-dir. Ancak anevrizma varlığı gösterilemeyen olgularda da (örneğin hipertansif hemoraji ile ilişkili) SAK gelişimi bildirilmektedir. Amacımız OFZ'li bir olguda gelişen SAK'ın OFZ ile ilişkisini tartışmaktır. Otuz-dokuz yaşında erkek hasta bilinç kaybı yakınması ile başvurdu. Anamnezinde organofosfatlı tarım ilacından 150 cc içtiği öğrenildi. Başvuruda Glasgow koma skala (GKS) skoru 3 idi ve yarım saat sonra 11'e yükseldi. Tansiyon arteryal (TA) 120/90 mm/Hg, nabız 112/dk ve ateş 37,2 C° idi. Pupiller miyotik (2mm/2mm), ışık refleksi zayıf alınıyordu. Hiçbir fokal nörolojik defisiti yoktu ve meningismus bulguları saptanmadı. Kan kolinesteraz (ChE) düzeyi 121 u/L (3600-12000 u/L) olarak ölçüldü. Başvurudan 18 saat sonra TA 200/130 mm/Hg oldu. Bu arada GKS skoru 4'e geriledi ve beyin tomografisinde (BT) SAK ile uyumlu bulgular vardı. Tekrar edilen serum ChE'ı 1908 u/L idi. Hasta 7. günde kardiyopulmoner arrest sonucu eksitus oldu. Olgumuz, OFZ'li olgularda, özellikle şiddetli olanlarda, sempatik sistem hiperaktivasyonuna bağlı hipertansif kriz ve bununla ilişkili SAK'ın olabileceğini gösterebilir.
Subarachnoid Hemorrhage in a Case with Organophospate Poisoning
Althought the findings of involvement of parasympatic nerve system are common in the patients with organophospate poisoning (OPP), findings such as hypertension associated with the sympatic hyperactivitiy infrequently may be established. Subarachnoid hemorrhage (SAH) often occurs due to the rupture of cerebral aneurysms or arteriovenous malformations (AVM). However it has been reported that SAH may also develop due to nonaneurysmal c a u s e s such as hypertensive hemorrhage. Our aim is to discuss the association with OPP of SAH in a case with OPP. A thirty-nine old man, presented with the loss of conscious. He ingested approximately 150 cc of a commercial formulation of dimetylamin. Glasgow coma scala (GCS) score was 3 on admission and was 11 thirty minute later. Tension arterial (TA) was 120/900 mm/Hg, pulse rate was 112/minute, tempareture was 37.2 C°. Pupillaries were myotic (2 mm/ 2 mm) and unreactive to light. There was no focal norologic defisite including meningismus findings. Blood cholinesterase (ChE) level was measured as 121 u/L (3600-12000 u/L). Eighteen hours after admission TA was 200/130 mm/Hg with GCS score of 4. Cranial computed tomografy (CT) revealed SAH. Repeteated blood ChE level was 1908 . He died as a result of cardiyopulmonary arest on day 7th. Our case may show SAH in association with hypertensive crisis due to sympatic hyperactivation in patients with OPP, especially in those with severe poisoning.
Keywords
References
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Abstract
References
- Öztürk MA, Kelestimur F, Kurtoglu S, et al. Anticholinesterase poisoning in Turkey - clinical, laboratory and radiolojic evaluation of 269 cases. Hum Exp Toxicol 1990; 9: 273-279.
- Namba T, Nolte CT, Jackrel J, et al. Poisoning due to organophospate insecticides. Acute and chronic manifestations . Am J Med. 1971; 50: 475-492.
- Guven M, Unluhizarci K, Goktas Z, Kurtoglu S: Intravenous organophospate injection: an unusual way of intoxication. Hum Exp Toxicol. 1997; 16 : 279-280.
- Midtling J, Barnet P, Coye M, et al. Clinical management of field worker organophosphate poisoning. West J Med. 1985 Apr; 142(4): 514-8.
- Wolter C, Robey III, William JM. Insecticides, Herbicides, Rodenticides. In: Tintinalli JE, Kelen GD, Stabczynski JS (eds). Emergency Medicine A Comprehensive Study Guide. 5rd ed. North Carolina, The Mc Graw Hill Companies, 2000; 1174-1182.
- Selman WR, Tarr RW, Ratcheson RA. Intracranial aneurysms and a subarachnoid hemorrage. In: Bradley WG, Daroff RB, Fenichel GM, Marsdan CD (eds.). Neurology in clinical practice. 3 rd ed. Boston, Butterworth Heinemann, 2000; 1185-1199.
- Chuang FR, Jang SW, Lin JL, et al. QTc prolangation indicates a poor prognosis in patients with organophospate poisoning. Am J Emer Med. 1996; 14: 451-453
Details
| Primary Language | English |
|---|---|
| Journal Section | Basic Medical Sciences |
| Authors | |
| Publication Date | December 31, 2009 |
| Submission Date | October 28, 2009 |
| Published in Issue | Year 2005 Volume: 22 Issue: 2 |
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