Acute carbon monoxide poisoning: MR imaging findings with clinical correlation

Kim, D.M.; Lee, Inho; Park, J.Y.; Hwang, Seung Bae; Yoo, Dong-Soo; Song, Chang Hun

doi:10.1016/j.diii.2016.10.004

Cited by 33 publications

(26 citation statements)

References 10 publications

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“…There were some studies in the literature that had discussed the relationship between CO intoxication and globus pallidus necrosis (Table 4). Most of the studies were from Asian countries, and the incidence rates of globus pallidus necrosis after CO intoxication ranged between 18.7% and 100% [4,10,11,12,13,14,15,16,17,18,19,20]. Nevertheless, the sources of CO were not mentioned in many of the studies.…”

Section: Discussionmentioning

confidence: 99%

Incidence Rate and Predictors of Globus Pallidus Necrosis after Charcoal Burning Suicide

Huang

Hsu

et al. 2019

IJERPH

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Objective: This study examined predictors of globus pallidus necrosis as there was a paucity of literature of globus pallidus necrosis resulted from carbon monoxide poisoning after charcoal burning suicide. Methods: A total of 67 patients who had attempted charcoal burning suicide were recruited and stratified into two subgroups based on either presence (n = 40) or absence (n = 27) of globus pallidus necrosis. Demographic, clinical, laboratory, and radiographic data were obtained for cross-sectional analysis. All patients were followed to investigate the risks for mortality. Results: The patients aged 36.8 ± 11.1 years (67.2%) were male. Patients with globus pallidus necrosis were younger (p = 0.044) and had less hypertension (p = 0.015) than patients without globus pallidus necrosis. Furthermore, patients with globus pallidus necrosis suffered from severer medical complications, i.e., fever (p = 0.008), acute myocardial injury (p = 0.022), acute rhabdomyolysis (p = 0.022), and neuropsychiatric symptoms (p < 0.001) than patients without globus pallidus necrosis. Moreover, patients with globus pallidus necrosis received less hyperbaric oxygen therapy than without necrosis (p = 0.024). Two patients (3.0%) died on arrival. In a multivariable regression model, it was revealed that acute myocardial injury (odds ratio 4.6, confidence interval 1.1–18.9, p = 0.034) and neuropsychiatric symptoms (odds ratio 8.0, confidence interval 2.0–31.4, p = 0.003), decreased blood bicarbonate level (odds ratio 0.8, confidence interval 0.7–1.0, p = 0.032), and younger age (odds ratio 0.9, confidence interval 0.9–1.0, p = 0.038) were significant predictors for globus pallidus necrosis. Conclusion: Although patients who had attempted charcoal burning suicide had a low mortality rate (3.0%), globus pallidus necrosis was not uncommon (59.7%) in this population. Further studies are warranted.

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Section: Discussionmentioning

confidence: 99%

Incidence Rate and Predictors of Globus Pallidus Necrosis after Charcoal Burning Suicide

Huang

Hsu

et al. 2019

IJERPH

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“…CT and MRI scans were usually performed on patients exposed to CO despite the lack of CNS lesion symptoms or CO exposure-related symptoms. Delays in symptom presentation often led to late diagnoses [19][20][21][22].…”

Section: White Mattermentioning

confidence: 99%

“…Kim, et al [21], stated that CO poisoning has no indicative signs or symptoms, and diagnosis may be difficult without the patient's CO exposure history. Devine, et al [23], and Kaphan, et al [24] added that patients exposed or presumed to have been exposed to CO should be monitored over the long term through a series of neuropsychological tests.…”

Section: White Mattermentioning

confidence: 99%

Untitled

2021

IJHMS

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Carbon monoxide (CO) poisoning is a major public health issue in the United States that accounts for approximately 50% of poisoning cases in the nation each year and around 50,000 emergency room visits. In most instances of CO poisoning, the culprit is a malfunctioning or poorly tended heating system within the home or, occasionally, commercial building, which causes the system to leak this hazardous gas. One of the more insidious aspects of CO poisoning is that the gas is odorless and colorless, and victims of CO poisoning often do not realize that there is a problem until they begin to experience the effects of poisoning and have no choice but to seek medical attention. Unfortunately, many victims of CO poisoning die before they are able to seek treatment. This paper makes use of a qualitative, systematic literature review to examine the four major parts of the brain that are most severely affected by CO poisoning. Overall, the literature review showed that the white matter, globus pallidus, basal ganglia, and cortex are the parts of the brain most severely impacted by CO poisoning. While many CO poisoning victims do make it to the hospital on time and are treated, they may nonetheless suffer long-term neurological consequences as a result of their exposure. As such, CO poisoning is a major public health issue.

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“…Last, with respect to the correlation among levels of CO exposure, neuropsychiatric scores, and DKI metrics, previous studies have shown that there is no definite relationship among carboxyhemoglobin levels, the severity of MR imaging findings, and the length of exposure time. 39 Limitations First, DKI metrics were measured on the basis of ROIs manually placed in various regions, which might yield imperfect reference values and were thus biased. Second, only limited neuropsychological tests were performed, possibly underestimating the cognitive sequelae.…”

Section: Kfa Value Predicted Clinical Performancementioning

confidence: 99%

Cerebral Damage after Carbon Monoxide Poisoning: A Longitudinal Diffusional Kurtosis Imaging Study

Lei¹,

Wang

Lei³

et al. 2019

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Previous DTI cross-sectional studies have showed the cerebral damage feature was different in the three clinical stages after carbon monoxide poisoning. Diffusional kurtosis imaging (DKI) is an advanced diffusion imaging model and considered to better provide microstructural contrast in comparison with DTI parameters. The primary aim of this study was to assess microstructural changes in gray and white matter with diffusional kurtosis imaging in the acute, delayed neuropsychiatric, and chronic phases after acute carbon monoxide (CO) poisoning. The secondary aim was to relate diffusional kurtosis imaging measures to neuropsychiatric outcomes of acute carbon monoxide poisoning. MATERIALS AND METHODS: In all, 17 patients with acute carbon monoxide poisoning and 30 sex-and age-matched healthy volunteers were enrolled in the study. Patients were scanned within 1 week, 3-8 weeks, and 6 months after acute carbon monoxide poisoning. Diffusional kurtosis imaging metrics including mean kurtosis, mean diffusivity, fractional anisotropy, and kurtosis fractional anisotropy were measured in 11 ROIs and then further correlated with neuropsychiatric scores. RESULTS: In WM, mean kurtosis tended to increase from the acute-to-delayed neuropsychiatric phases and then decrease in the chronic phase, while in GM mean kurtosis showed a constant decline. Contrary to mean kurtosis, mean diffusivity first decreased then tended to increase in WM, while in GM, from the acute to chronic phases, mean diffusivity showed a constant increase. In both WM and GM, the fractional anisotropy and kurtosis fractional anisotropy values progressively declined with time. Kurtosis fractional anisotropy showed the best diagnostic efficiency with an area under the curve of 0.812 (P =. 000). Along with neuropsychiatric scores, kurtosis fractional anisotropy of the centrum semiovale and Digit Span Backward were most relevant (r = 0.476, P =. 000). CONCLUSIONS: Longitudinally, microstructural changes were inconsistent in WM and GM with time after acute carbon monoxide poisoning. Diffusional kurtosis imaging metrics provided important complementary information to quantify the damage to cognitive impairment. ABBREVIATIONS: CS ¼ centrum semiovale; DKI ¼ diffusional kurtosis imaging; DNS ¼ delayed neuropsychiatric; FA ¼ fractional anisotropy; GP ¼ globus pallidus; KFA ¼ kurtosis fractional anisotropy; MD ¼ mean diffusivity; MK ¼ mean kurtosis; CC ¼ corpus callosum C arbon monoxide (CO) poisoning often results in serious cerebral damage. On the basis of clinical behavior, surviving patients usually present with 3 clinical phases: the acute, delayed neuropsychiatric (DNS), and chronic. In the acute phase, a patient with a definite history of acute CO poisoning presents with acute and transient clinical symptoms. The DNS phase represents recurrent neuropsychiatric symptoms after the apparent resolution of acute symptoms (a lucid interval from 2 to 40 days; mean duration, 22 days). Furthermore, patients in the chronic phase present symptoms from ...

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Acute carbon monoxide poisoning: MR imaging findings with clinical correlation

Abstract: Bilateral globi pallidi with restricted diffusion may be a characteristic MRI feature in patients with acute CO poisoning. However, the relationship was not certain between the carboxyhemoglobin levels and the variety or severity of MRI findings.

Cited by 33 publications

References 10 publications

Incidence Rate and Predictors of Globus Pallidus Necrosis after Charcoal Burning Suicide

Incidence Rate and Predictors of Globus Pallidus Necrosis after Charcoal Burning Suicide

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Cerebral Damage after Carbon Monoxide Poisoning: A Longitudinal Diffusional Kurtosis Imaging Study

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