The Enigma of Delayed Neurotoxicity in Organophosphate Poisoning: A Case Report of Clinical Presentation With Normal MRI Findings

Organophosphate (OP) poisoning can cause delayed neurotoxicity, a condition where neurological symptoms appear weeks after the initial exposure. This case report describes a patient who developed weakness and other neurological issues five weeks after being poisoned with chlorpyrifos, an organophosphate pesticide. The patient initially showed symptoms of acute poisoning, including altered sensorium and breathing difficulty, but recovered after treatment. However, he later developed weakness in his legs, difficulty walking, and sensory loss, indicating delayed neurotoxicity. Despite the neurological symptoms, an MRI of the patient's spine was normal. This highlights the importance of a thorough clinical assessment in patients with potential OP-induced delayed neurotoxicity, even when imaging results are unremarkable.

• 1
  A 28-year-old male developed delayed myelopathy five weeks after acute chlorpyrifos poisoning, presenting with lower limb weakness, abnormal gait, and sensory loss.
• 2
  Despite clinically evident myelopathy, the patient's MRI of the spine was normal, emphasizing the challenge in diagnosing OPIDN.
• 3
  Electrodiagnosis revealed sensory-motor axonal involvement in lower limbs, supporting the diagnosis of organophosphate-induced delayed neurotoxicity.