ĐẶC ĐIỂM LÂM SÀNG VÀ HÌNH ẢNH HỌC Ở BỆNH NHÂN NGỘ ĐỘC CẤP HÓA CHẤT BẢO VỆ THỰC VẬT MỚI NỔI CÓ TỔN THƯƠNG THẦN KINH TRUNG ƯƠNG

Abstract

Background: Acute emerging pesticide poisonings such as fluoroacetate, glufosinate, and diquat exhibit high neurotoxicity to the central nervous system (CNS), often resulting in death or severe sequelae. Objective: To describe the clinical and brain MRI characteristics of patients with acute poisoning from emerging pesticides. Methods: A observational study was conducted on 98 acute poisoned patients by fluoroacetate, glufosinate, and diquat treated at the Poison Control Center of Bach Mai Hospital, from January 2024 to June 2025. Results: The mean patient age was 41 ± 15.7 years old, with males accounting for 58.2%. Fluoroacetate was the most common agent (73.5%), followed by glufosinate (15.3%) and diquat (11.2%). Gastrointestinal symptoms were the most common onset symptoms (54.2-100%), while fluoroacetate and glufosinate also caused early neurological manifestations (30.6-40%). Glufosinate frequently induced severe impaired consciousness (66.7% GCS ≤14), fluoroacetate was associated with seizures and rigidity, whereas most diquat cases developed coma late, but with high mortality rate (72.3%). MRI revealed diffuse white matter injury with fluoroacetate, predominantly involving the corpus callosum (95.8%) and centrum semiovale (59.7%); corpus callosum lesions with glufosinate (86.7%); and brainstem involvement with diquat (pons 63.6%, medulla oblongata 36.4%), frequently accompanied by cerebral edema (36.4%) and brain herniation (9.1%). Conclusion: Acute poisoning from emerging pesticides presented with distinctive clinical and MRI features specific to each agent. Brain MRI is a valuable tool for diagnosis, prognosis, and guiding therapeutic decisions.