Polineuropatia por triclorfon registro de um caso com estudo eletrofisiodógico e histopatológico do nervo sural

Freitas, Marcos R. G. de; Chimelli, Leila; Nascimento, Osvaldo J. M.; Cincinatus, Daniel; Marques, Hélio A.; Nevares, Maria Tereza

doi:10.1590/S0004-282X1990000400019

Resumos

É apresentado caso de paciente agricultor que, após uso inadequado de inseticida organofosforado (triclorfon), teve sinais e sintomas de intoxicação aguda e, três meses após, desenvolveu quadro de polineuropatia sensitivo-motora. O exame eletroneuromiográfico revelou alterações axonais e desmielinizantes difusas. O estudo do nervo sural, em cortes semi-finos, à ultramicroscopia e à técnica de fibras isoladas revelou degeneração axonal e transformação granular do axoplasma com perda dos neurofilamentos e neurotúbulos.

The authors observed a patient who worked in a farm and suffered an organophosphate intoxication (trichlorphon). The immediate effect was manifested by vomiting and abdominal cramps. Three months later he presented a distal symmetric sensorimotor (predominantly motor) neuropathy with distal muscle atrophy. Electromyography has revealed denervation changes in every muscle studied and the sensory and motor nerve conduction was slowed in arms and legs. The sural nerve biopsy specimen studied by light microscopy with semi-thin section and teased fiber preparation showed axonal degeneration. The ultrastructural studies of the axonal alterations consisted of degeneration of the neurofilaments and the neurotubules with granular appearance of the axoplasm.

Polineuropatia por triclorfon registro de um caso com estudo eletrofisiodógico e histopatológico do nervo sural

Polyneuropathy following exposure to trichlorphon: report of a case with electrophysiological and nerve histological studies

Marcos R. G. de Freitas^I; Leila Chimelli^II; Osvaldo J. M. Nascimento^III; Daniel Cincinatus^III; Hélio A. Marques^III; Maria Tereza Nevares^IV

^IProfessor Adjunto e Chefe do Serviço de Neurologia - Trabalho das Disciplinas de Neurologia e Neuropatologia da Faculdade de Medicina da Universidade Federal Fluminense

^IIProfessor Adjunto de Neuropatologia - Trabalho das Disciplinas de Neurologia e Neuropatologia da Faculdade de Medicina da Universidade Federal Fluminense

^IIIProfessor Adjunto de Neurologia - Trabalho das Disciplinas de Neurologia e Neuropatologia da Faculdade de Medicina da Universidade Federal Fluminense

^IVMédico Residente em Neurologia - Trabalho das Disciplinas de Neurologia e Neuropatologia da Faculdade de Medicina da Universidade Federal Fluminense

RESUMO

É apresentado caso de paciente agricultor que, após uso inadequado de inseticida organofosforado (triclorfon), teve sinais e sintomas de intoxicação aguda e, três meses após, desenvolveu quadro de polineuropatia sensitivo-motora. O exame eletroneuromiográfico revelou alterações axonais e desmielinizantes difusas. O estudo do nervo sural, em cortes semi-finos, à ultramicroscopia e à técnica de fibras isoladas revelou degeneração axonal e transformação granular do axoplasma com perda dos neurofilamentos e neurotúbulos.

SUMMARY

The authors observed a patient who worked in a farm and suffered an organophosphate intoxication (trichlorphon). The immediate effect was manifested by vomiting and abdominal cramps. Three months later he presented a distal symmetric sensorimotor (predominantly motor) neuropathy with distal muscle atrophy. Electromyography has revealed denervation changes in every muscle studied and the sensory and motor nerve conduction was slowed in arms and legs. The sural nerve biopsy specimen studied by light microscopy with semi-thin section and teased fiber preparation showed axonal degeneration. The ultrastructural studies of the axonal alterations consisted of degeneration of the neurofilaments and the neurotubules with granular appearance of the axoplasm.

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Dr. Marcos R. G. de Freitas - Rua Gastão Ruch 16 aptº 1402 - 24220 Niterói RJ - Brasil.

1. Abou-Donia MP - Organophosphorous ester-induced delayed neurotoxicity. Ann Rev Pharmacol Toxicol 21:511, 1981.
2. Alonso JL, Atalla A, Cavaliere MJ, Gagioti SM, Lorenti MAA - Polineuropatia por parathion: estudo clínico, eletrofisiológico e histológico de um caso. Arq Neuro-Psiquiat (São Paulo) 41:292, 1983.
3. Bouldin TW, Cavanagh JB - Organophosphorus neuropathy: I. A teased-fiber study of the spatio-temporal spread of axonal degeneration. Am J Pathol 94:241, 1979.
4. Bouldin TW, Cavanagh JB - Organophosphorus neuropathy: II. A fine-structural study of the early stages of axonal degeneration. Am J Pathol 94:253, 1979.
5. Hierons R, Johnson MK - Clinical and toxicological investigations of a case of delayed neuropathy in man after acute poisoning by an organophosporus pesticide. Arch Toxicol 40:279, 1978.
6. Johnson MK - Delayed neurotoxicity: do trichlorphon and dichlorvos cause delayed neuropathy in man or in-test animals? Acta Pharmacol Toxicol 49:87, 1981.
7. Lotti M, Becker C, Aminoff MJ - Organophosphorus polyneuropathy: pathogenesis and prevention. Neurology 34:658, 1984.
8. Namba T, Noite CT, Jackrel J, Grob D - Poisoning due to organophosphate inseticides. AM J Med 50:475, 1971.
9. Novak EM, Werneck LC - Comprometimento neurológico por inseticidas: estudo das manifestações crônicas em 13 casos. Arq Neuro-Psiquiat (São Paulo) 35:129 1977.
10. Pollingher B, Cozma V, Oprisan C - Clinical and eletromyognaphic study of two cases of severe polyneuritis following acute poisoning with neguvon (organophosphoric pesticide). Electroenceph Clin Neurophysiol 35:433, 1973.
11. Schamburg HH, Spencer PS - Human toxic neuropathy due to industrial agents. In Dick PJ, Thomas PK, Lambert EH, Bunge R (eds): Peripheral Neuropathy, Vol 2. WB Saunders, Philadelphia, 1984, pg 2115.
12. Senanayake N, Karalliedde L - Neurotoxic effects of organophosphorus inseticides: an intermediate syndrome. N Engl J Med 316:761, 1987.
13. Wadia RS, Sadagopan C, Amin RB, Sardesai HV - Neurological manifestations of organophosphorus inseticide poisoning. J Neurol Neurosurg Psychiat 37:841, 1974.
14. Werneck LS, Novak EM - Intoxicações por inseticidas: microdissecção de nervos e histoquímioa de músculos em 10 casos. Ara Neuro-Psiquiat (São Paulo) 37:15, 1979.

Datas de Publicação

Publicação nesta coleção
19 Maio 2011
Data do Fascículo
Dez 1990

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Abou-Donia MP - Organophosphorous ester-induced delayed neurotoxicity. Ann Rev Pharmacol Toxicol 21:511, 1981.

[2] 2. Alonso JL, Atalla A, Cavaliere MJ, Gagioti SM, Lorenti MAA - Polineuropatia por parathion: estudo clínico, eletrofisiológico e histológico de um caso. Arq Neuro-Psiquiat (São Paulo) 41:292, 1983.

[3] 3. Bouldin TW, Cavanagh JB - Organophosphorus neuropathy: I. A teased-fiber study of the spatio-temporal spread of axonal degeneration. Am J Pathol 94:241, 1979.

[4] 4. Bouldin TW, Cavanagh JB - Organophosphorus neuropathy: II. A fine-structural study of the early stages of axonal degeneration. Am J Pathol 94:253, 1979.

[5] 5. Hierons R, Johnson MK - Clinical and toxicological investigations of a case of delayed neuropathy in man after acute poisoning by an organophosporus pesticide. Arch Toxicol 40:279, 1978.

[6] 6. Johnson MK - Delayed neurotoxicity: do trichlorphon and dichlorvos cause delayed neuropathy in man or in-test animals? Acta Pharmacol Toxicol 49:87, 1981.

[7] 7. Lotti M, Becker C, Aminoff MJ - Organophosphorus polyneuropathy: pathogenesis and prevention. Neurology 34:658, 1984.

[8] 8. Namba T, Noite CT, Jackrel J, Grob D - Poisoning due to organophosphate inseticides. AM J Med 50:475, 1971.

[9] 9. Novak EM, Werneck LC - Comprometimento neurológico por inseticidas: estudo das manifestações crônicas em 13 casos. Arq Neuro-Psiquiat (São Paulo) 35:129 1977.

[10] 10. Pollingher B, Cozma V, Oprisan C - Clinical and eletromyognaphic study of two cases of severe polyneuritis following acute poisoning with neguvon (organophosphoric pesticide). Electroenceph Clin Neurophysiol 35:433, 1973.

[11] 11. Schamburg HH, Spencer PS - Human toxic neuropathy due to industrial agents. In Dick PJ, Thomas PK, Lambert EH, Bunge R (eds): Peripheral Neuropathy, Vol 2. WB Saunders, Philadelphia, 1984, pg 2115.

[12] 12. Senanayake N, Karalliedde L - Neurotoxic effects of organophosphorus inseticides: an intermediate syndrome. N Engl J Med 316:761, 1987.

[13] 13. Wadia RS, Sadagopan C, Amin RB, Sardesai HV - Neurological manifestations of organophosphorus inseticide poisoning. J Neurol Neurosurg Psychiat 37:841, 1974.

[14] 14. Werneck LS, Novak EM - Intoxicações por inseticidas: microdissecção de nervos e histoquímioa de músculos em 10 casos. Ara Neuro-Psiquiat (São Paulo) 37:15, 1979.