Objective: Hyperkinesias are a type of movement disorders characterized by involuntary muscle movements. There are different variants of hyperkinesia, including tremor, chorea, myoclonic movements, etc. They could be idiopathic, hereditary or secondary. One of the main causes for secondary movement disorders are intoxications. Organophosphate compounds (OPC) are a diverse group of chemicals used in both domestic and industrial settings. The primary mechanism of action of OP pesticides is inhibition of carboxyl ester hydrolases, particularly acetylcholinesterase. Clinical effects are manifested via activation of autonomic and central nervous systems.

Background: A 77 year old patient was admitted to our clinic with high blood pressure and series of epileptic seizures within the last hour. On admission the patient was alert and orientated, neurological examination revealed no abnormalities; during observation another secondary generalized epileptic seizure occurred. CT scan was performed and was normal. The next day no seizures were registered, level of consciousness gradually decreased and myoclonic hyperkinesia was noticed in upper extremities.

Methods: EEG revealed abnormally slow delta background without focal and epileptic activities. Laboratory tests and brain MRI were without obvious abnormalities.

Results: Thorough history taking revealed that in the morning of illness patient was working in her balcony garden with chemicals containing OPC, taking into consideration the results of laboratory and clinical tests, diagnosis of OPC intoxication was established. On appropriate treatment patient was discharged from hospital without any complaint.

Conclusions: Even though the main appearance of patient was neurological, other secondary non neurological causes including intoxication should be always kept in mind.

References: n/a

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-case-of-secondary-myoclonic-hyperkinesia/