Background: Organophosphorous (OP) poisoning can result in significant morbidity and mortality, particularly in agricultural workers. Even while respiratory depression and cholinergic crisis are the usual symptoms, ischemic infarction, as a central nervous system involvement, is infrequently documented.

Case report: A case of 47-year-old male with occupational pesticide exposure who developed a lower level of consciousness after probable acute chlorpyrifos poisoning during pesticide spraying. On admission, he showed signs of cholinergic toxicity and required critical management, including intubation and mechanical ventilation. Despite rapid treatment with atropine, obidoxime, and supportive measures, neurological impairments persisted. A CT scan of the brain revealed bilateral thalamic and brainstem infarctions.

Conclusion: This case adds to the limited literature on the cerebrovascular consequences of acute organophosphate (OP) poisoning, manifesting as an ischemic stroke shortly after exposure. It shows vascular involvement that might be linked to OP poisoning, which goes beyond the traditional cholinergic crisis and emphasizes the importance of being aware of such unusual presentations, particularly in occupational settings.