Carbon monoxide poisoning: clinical, neurophysiological, and brain imaging observations in acute disease and follow-up

Abstract

Five patients (aged 19-52 years) were treated for a midbrain syndrome due to acute carbon monoxide poisoning and had clinical follow-up investigations for up to 18 months. Three patients recovered with minor neurological and neuro-psychological deficits and resumed their premorbid life-style. One patient had normal findings, while the fifth remained in a permanent vegetative state. Initial CT of the brain may fail to detect low-density lesions in the globus pallidus. If present, these lesions may either have disappeared, diminished, or remained unchanged at follow-up. Long-term outcome seems to show a closer link to white matter changes, which are at present best investigated by magnetic resonance imaging. The additional value of determining visual evoked responses at repeated follow-up is suggested by the present investigation.

Uncommon MRI and Echocardiographic Findings in a Patient of Carbon Monoxide Poisoning

“…However, a well-documented CT finding in CO exposure is low density lesions in bilateral globus pallidus [16]. The reason for development of this lesion has been linked to decrease in local low blood flow to the globus pallidus [17], metabolic acidosis, and hypotension in animal models. Globus pallidus lesions may be delayed for several days after presentation and may resolve gradually [18].…”

MRI and neuropsychological correlates of carbon monoxide exposure: a case report.

“…The white matter changes are thought to represent reversible demyelination (3). Vieregge et al (5) reported that the white matter changes were more predictive of outcome than the globus pallidus changes. Although the vast majority of lesions reported in the literature are in the globus pallidus and white matter, lesions in other brain areas have been reported, including the hippocampus (6), thalamus, medial temporal lobe, cerebellum (1), parietal lobe, occipital lobe, and frontal lobe (7).…”

Neurologic and Pregnancy Effects of Carbon Monoxide Exposure

“…Case series most commonly identify depression and anxiety, but other psychiatric effects such "personality changes" have been described [52][53][54][55]. These studies are also of limited size and suffer from a lack of consistent methodologies, do not always control for malingering or effort, have significant selection bias, and non-uniform follow-up.…”