Manifestation of acute stroke symptoms as toxic effects after flonicamid/sulfoxaflor pesticide poisoning

Global concern has focused on reducing the potential hazards to public health from unintentional pesticide poisoning. As a result, notorious agents have been banned from the market, and new materials that maintain their effectiveness against harmful insects with low human toxicity have been developed. Despite the development of several recent agents targeting the nervous system of insects, their clinical effects on humans are rarely known. We report a novel human intoxication with a mixture of flonicamid and sulfoxaflor pesticides, which presented with acute stroke manifestations. An 83-year-old man presented to the emergency department (ED) in a confused mental state and with right-sided hemiparesis for 2 h prior to the visit. The primary evaluation targeted a new onset of hemorrhagic stroke. Clinical manifestations showed no definite interval change for 2 days, and the diagnosis of stroke was ruled out after previous radiologic results revealed the presence of a pre-existing lesion. After 3 days, the patient recovered with an alert mentality and appropriate orientation. The patient remembered that he took the package of pesticide but flatly denied the intentional intake of toxic agents. The patient was discharged 5 days after admission without any neurological deficits. We present the first report of human intoxication with flonicamid or sulfoxaflor. Although the total amount of ingestion was not high, the patient showed unique clinical manifestations of stroke. Physicians should be aware of particular toxic materials when a differential diagnosis of stroke is required. Further investigations should be performed to estimate and reveal human toxicity.