Cerebral metabolic changes in delayed carbon monoxide sequelae studied by proton MR spectroscopy

Kamada, Kohei; Houkin, Kiyohiro; Aoki, Takeshi; Koiwa, Mitsuyuki; Kashiwaba, Takeshi; Iwasaki, Yoshinobu; Abe, Hiroshi

doi:10.1007/bf00588070

Cited by 28 publications

(13 citation statements)

References 11 publications

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“…All of these lesions were symmetrical. The lesion distribution pattern of our cases was similar to the previous MRI-confirmed cases in the chronic phase of CO poisoning (table 3) [2, 18, 23, 24, 25, 26, 27, 28, 29, 30]. …”

Section: Resultssupporting

confidence: 69%

Diffusion-Weighted MRI and <sup>99m</sup>Tc-HMPAO SPECT in Delayed Relapsing Type of Carbon Monoxide Poisoning: Evidence of Delayed Cytotoxic Edema

Chu¹,

Jung²,

Kim³

et al. 2004

Eur Neurol

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Background: Carbon monoxide (CO) is a common cause of poisoning, and its sequelae include a progressive (25%) and a delayed relapsing form (75%). We report the diffusion-weighted MRI (DWI) findings in the delayed relapsing form of CO poisoning and characterize the types of edema. Methods: From November 1, 2000 to June 1, 2003, 5 consecutive patients (2 men, 3 women, range of age: 54–67 years), who had the delayed relapsing type of CO poisoning, underwent DWI, conventional MRI, MR angiography and SPECT. CO poisoning was diagnosed by the presence of a typical clinical history, an abnormally increased level of serum carboxyhemoglobin and MRI findings. Apparent diffusion coefficient (ADC) values were measured in all of the abnormal lesions with visual inspection of DWI and T₂-weighted echo-planar imaging. Results: DWI showed high signal intensities in bilateral periventricular white matter, in the splenium of the corpus callosum, in internal capsules, and brainstem showing moderately decreased ADC values. In the globus pallidus, the ADC values were rather increased with low signal intensities on DWI. Brain SPECT showed decreased perfusion in bilateral white matter and some parts of the cerebral cortex, which correlated well with the DWI findings. Conclusions: We suggest that prominent, symmetric restricted diffusion can occur in periventricular white matter, brainstem, and corpus callosum after the delayed relapsing type of CO poisoning. Delayed cytotoxic edema can occur in this setting, which provides a new guidance for the pathogenesis of CO poisoning and the differential diagnosis of white matter diseases.

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Section: Resultssupporting

confidence: 69%

Diffusion-Weighted MRI and <sup>99m</sup>Tc-HMPAO SPECT in Delayed Relapsing Type of Carbon Monoxide Poisoning: Evidence of Delayed Cytotoxic Edema

Chu¹,

Jung²,

Kim³

et al. 2004

Eur Neurol

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“…In WM, the MRS showed an overall pattern of decaying NAA/Cr, which stabilized or normalized in the patients with better outcomes. This finding is in agreement with previous case reports [9,10,14,26].…”

Section: N-acetyl Aspartatesupporting

confidence: 96%

“…Patients 6 and 7 had transiently increased Cho/Cr in the GM. The WM Cho/Cr increased in patients 4, 5, 6 and 7, and there was a tendency towards normalization of values on long-term follow-up, which is in agreement with previous reports [9,10,14,26]. An early increase in Cho/Cr may be related to poorer longterm outcome, as seen in patients 6 and 7, but this must be conformed by future studies.…”

Section: Total Cholinesupporting

confidence: 92%

1H MR spectroscopy of gray and white matter in carbon monoxide poisoning

et al. 2009

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Carbon monoxide (CO) intoxication leads to acute and chronic neurological deficits, but little is known about the specific noxious mechanisms. (1)H magnetic resonance spectroscopy (MRS) may allow insight into the pathophysiology of CO poisoning by monitoring neurochemical disturbances, yet only limited information is available to date on the use of this protocol in determining the neurological effects of CO poisoning. To further examine the short-term and long-term effects of CO on the central nervous system, we have studied seven patients with CO poisoning assessed by gray and white matter MRS, magnetic resonance imaging (MRI) and neuropsychological testing. Five patients suffered from acute high-dose CO intoxication and were in coma for 1-6 days. In these patients, MRI revealed hyperintensities of the white matter and globus pallidus and also showed increased choline (Cho) and decreased N-acetyl aspartate (NAA) ratios to creatine (Cr), predominantly in the white matter. Lactate peaks were detected in two patients during the early phase of high-dose CO poisoning. Two patients with chronic low-dose CO exposure and without loss of consciousness had normal MRI and MRS scans. On follow-up. five of our seven patients had long-lasting intellectual impairment, including one individual with low-dose CO exposure. The MRS results showed persisting biochemical alterations despite the MRI scan showing normalization of morphological changes. In conclusion, the MRS was normal in patients suffering from chronic low-dose CO exposure; in contrast, patients with high-dose exposure showed abnormal gray and white matter levels of NAA/Cr, Cho/Cr and lactate, as detected by (1)H MRS, suggesting disturbances of neuronal function, membrane metabolism and anaerobic energy metabolism, respectively. Early increases in Cho/Cr and decreases of NAA/Cr may be related to a poor long-term outcome, but confirmation by future studies is needed.

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“…Restricted diffusivity in the white matter lesions suggesting cytotoxic edema was demonstrated in studies using DWI [11,12,13,14,15,16,17]. An increased Cho/Cr ratio, a markedly low NAA/Cr ratio, and the presence of a lactate peak were observed in studies using 1 H-MRS [11,18,19,20]. Furthermore, marked decreases in FA and MD have so far been shown in only one study using DTI [21].…”

Section: Discussionmentioning

confidence: 99%

Serial Assessments of Delayed Encephalopathy after Carbon Monoxide Poisoning Using Magnetic Resonance Spectroscopy and Diffusion Tensor Imaging on 3.0T System

Terajima¹,

Igarashi²,

Hirose

et al. 2007

Eur Neurol

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To elucidate the still unclear mechanism of delayed encephalopathy after carbon monoxide (CO) poisoning, we serially performed single-voxel proton magnetic resonance spectroscopy (¹H-MRS) and diffusion tensor imaging (DTI) on a 3.0T system and intelligence tests in 2 patients, while they were undergoing hyperbaric oxygenation therapy. The chronological changes in ¹H-MRS- and DTI-derived parameters indicated the following: (1) White matter demyelination, aerobic metabolism inhibition, and cytotoxic edema persisted for at least 3 months even after starting the hyperbaric oxygenation therapy; (2) the axonal function and structural integrity of the white matter were initially severely impaired and then gradually and partially improved for 5 months, showing changes similar to those in the scores of the intelligence tests. The results demonstrated that brain damage after CO poisoning may persist longer than expected, and that the ¹H-MRS- and DTI-derived parameters are good indicators of the clinical progress of a patient. The combination of ¹H-MRS and DTI on a 3.0T system is useful for monitoring the changes in brain damage and the clinical symptoms of patients with delayed encephalopathy after CO poisoning.

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Cerebral metabolic changes in delayed carbon monoxide sequelae studied by proton MR spectroscopy

Cited by 28 publications

References 11 publications

Diffusion-Weighted MRI and <sup>99m</sup>Tc-HMPAO SPECT in Delayed Relapsing Type of Carbon Monoxide Poisoning: Evidence of Delayed Cytotoxic Edema

Diffusion-Weighted MRI and <sup>99m</sup>Tc-HMPAO SPECT in Delayed Relapsing Type of Carbon Monoxide Poisoning: Evidence of Delayed Cytotoxic Edema

1H MR spectroscopy of gray and white matter in carbon monoxide poisoning

Serial Assessments of Delayed Encephalopathy after Carbon Monoxide Poisoning Using Magnetic Resonance Spectroscopy and Diffusion Tensor Imaging on 3.0T System

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