Subarachnoid hemorrhage in a case with organophospate poisoning

Abstract

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 causes 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 u/L. 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.