Samiye KOCAL, Ömer Yasir BOZ, Ahmet Talha OZTURK, Yalcin GOLCUK
Eurasian Journal of Toxicology - 2026;8(2):41-44
Acute altered mental status frequently prompts emergency stroke evaluation; however, toxic exposures may also present as stroke mimics. Human data regarding the neurological effects of tebuconazole, a triazole fungicide, remain extremely limited. A 70-year-old woman presented with sudden-onset nausea, dizziness, and transient impaired consciousness approximately one hour before admission. The previous day, she had sprayed a 25% tebuconazole-containing fungicide for approximately two hours without facial or respiratory protective equipment and reported direct perioral and perinasal contact, suggesting dermal exposure with possible inhalational absorption. Neurological examination demonstrated depressed consciousness (GCS 9), bilateral Babinski signs, and an estimated NIHSS score of 6-8 attributable primarily to impaired consciousness without focal neurological deficits. Laboratory investigations, toxicology screening, electrocardiography (QTc 390 ms), and electroencephalography were unremarkable. Brain CT, CT angiography, and diffusion-weighted MRI excluded acute ischemia and large-vessel occlusion. Following close observation and supportive management, the patient's neurological findings resolved completely within 12 hours. Environmental tebuconazole exposure may cause reversible toxic encephalopathy that closely mimics acute stroke despite unremarkable routine laboratory and neuroimaging findings. When neuroimaging is negative and altered consciousness predominates, clinicians should obtain a detailed recent pesticide exposure history and document possible dermal or inhalational exposure. This case illustrates that early recognition may facilitate appropriate supportive management while helping avoid unnecessary interventions, including intravenous thrombolytic therapy.
