Acute poisonings with organophosphate pesticides occur often. The acute phase is characterised by muscarinergic (miosis, bradycardia, hypotension, dyspnoea, cyanosis, salivation, vomiting, and diarrhoea) and nicotinergic symptoms (fasciculations, cramps, paralysis) as well as multiple central nervous manifestations (headache, anxiety, generalised weakness, confusion, convulsion, and coma) caused by an irreversible inhibition of acetylcholinesterase (AChE). In some patients the acute cholinergic crisis is followed by an intermediate syndrome characterised by weakness of proximal limb muscle, neck flexors, and respiratory muscles and paralysis of motor cranial nerves due to a neuromuscular junctional defect. A delayed polyneuropathy manifested as distal motor polyneuropathy may appear 2 to 3 weeks after poisoning.1

In addition, a limited number of case studies are available describing extrapyramidal manifestations after acute organophosphate poisoning such as dystonia,1 2 rest tremor,2cog wheel rigidity,2 and choreoathetosis.2-4Only one study describes a case of possible organophosphate induced parkinsonism. However, there was no clear relation between poisoning and extrapyramidal symptoms due to chronic organophosphate exposure and, in addition, numerous episodes of acute intoxication.5

To our knowledge, no patient has previously been documented presenting with the complete picture of transient severe parkinsonism including bradyphrenia, rigidity, rest tremor, akinesia, impairment of speech and swallowing, and salivation after acute organophosphate intoxication and, in …