Combined application of dexamethasone and hyperbaric oxygen therapy yields better efficacy for patients with delayed encephalopathy after acute carbon monoxide poisoning

Xiang, Wenping; Hou, Xue; Wang, Baojun; Li, Yuechun; Zhang, Jun; Jiang, Changchun; Liang, Furu; Pang, Jiangxia; Yu, Lehua

doi:10.2147/dddt.s126569

Cited by 36 publications

(24 citation statements)

References 22 publications

(22 reference statements)

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“…Carbon monoxide (CO) poisoning is not rare and the incidence of delayed encephalopathy after carbon monoxide poisoning (DEACMP) is relatively high. Approximately 13-50% of patients with severe CO poisoning suffer from memory impairment, cognitive dysfunction, and behavioral disorders after a lucid interval (usually 2 to 60 days) of normal or apparent recovery [1][2][3], and the patients' condition was evaluated by clinical cognitive tests. This complication in clinical practice is considered DEACMP [4], which is characterized by a long course, poor prognosis, and high disability rate.…”

Section: Introductionmentioning

confidence: 99%

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Abnormal degree centrality in delayed encephalopathy after carbon monoxide poisoning: a resting-state fMRI study

et al. 2020

Neuroradiology

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Purpose To explore neuropathologic mechanisms in functional brain regions in patients with delayed encephalopathy after carbon monoxide poisoning (DEACMP) from the perspective of the brain network nodes by resting-state functional magnetic resonance imaging (rs-fMRI). Methods The fMRI and cognitive assessments were performed in 25 patients with DEACMP and 25 age-, sex-and educationmatched healthy controls (HCs). Data analysis was performed via the degree centrality (DC) method. Then, the associations between the cognitive assessments and DC in the identified abnormal brain regions were assessed by using a correlation analysis. Results Compared with the HCs, the DEACMP patients displayed significantly decreased DC values in the right superior frontal gyrus, right precentral gyrus, right angular gyrus, right marginal gyrus, right hippocampus, and left thalamus but increased DC values in the right inferior frontal gyrus, right cingulate gyrus, left superior temporal gyrus, left medial temporal gyrus, right lingual gyrus, and right posterior cerebellar lobe, pons, and midbrain (GRF correction, voxel P value < 0.001, cluster P value < 0.01). The correlation analysis in the DEACMP group revealed that there was a negative correlation between the DC values in the right hippocampus and MMSE scores, whereas a positive correlation was observed in the right cingulate gyrus. Conclusions Patients with DEACMP exhibited abnormal degree centrality in the brain network. This finding may provide a new approach for examining the neuropathologic mechanisms underlying DEACMP.

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Section: Introductionmentioning

confidence: 99%

“…Serial DWI and 1 H-MRS measurements are useful in determining the tissue damage and long-term outcomes of delayed sequelae associated with the interval form of CO poisoning [7]. 1 H MRS is the most useful indicator in the clinical evaluation of patients with the interval KW and ML contributed equally to this work.…”

Section: Introductionmentioning

confidence: 99%

Abnormal degree centrality in delayed encephalopathy after carbon monoxide poisoning: a resting-state fMRI study

et al. 2020

Neuroradiology

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“…HBO has been a traditional method of treating DEACMP in basic and clinical studies. Dexamethasone combined with HBO therapy has been reported to have better efficacy than HBO alone [13]. Myelin basic protein (MBP) levels in cerebrospinal fluid decreases significantly after treatment.…”

Section: Discussionmentioning

confidence: 99%

Wallerian degeneration of bilateral cerebral peduncles after acute carbon monoxide poisoning

et al. 2020

BMC Neurol

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Background: Cases of Wallerian degeneration of bilateral cerebral peduncles after acute carbon monoxide poisoning have not yet been reported. To date, most of the delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) lesions captured in magnetic resonance imaging (MRI) has been located in the subcortical white matter and basal ganglia. Here we report two cases of DEACMP with abnormalities in the bilateral cerebral peduncles. The etiology of abnormalities, which were strictly confined to the bilateral cerebral peduncles, was Wallerian degeneration secondary to upstream nerve axonal damage, making this the first report on such bilateral cerebral peduncle abnormalities after DEACMP. Case presentation: In this report, we present two cases of DEACMP with abnormal signals in the bilateral cerebral peduncles captured during brain MRIs. Case 1 was of a 68-year-old man who presented with paroxysmal disturbance of the consciousness, left limb weakness for 16 days, and lagging responses for 2 days. Case 2 was of a 55-year-old man who was unconscious for 6 h. In addition to the above mentioned characteristics on the brain MRIs, the electroencephalography of case 1 indicated that his forehead scans had a mixture of wide sharp, sharp, and three-phase waves. Brain diffusion tensor imaging of case 2 further proved that the bilateral cerebral anomalies represented Wallerian degeneration secondary to upstream axonal damage. After the definitive diagnosis, the patients returned to the local hospital for hyperbaric oxygen therapy. Conclusions: Wallerian degeneration of the bilateral cerebral peduncles after acute carbon monoxide poisoning has never been reported before. The abnormal signals in the bilateral cerebral peduncles captured during brain MRIs indicated Wallerian degeneration secondary to upstream axonal damage; thus, these two cases may further our understanding of DEACMP imaging.

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“…In addition,relevant clinical studies have shown that short-term NBP and HBO have a good clinical effect on the recovery of the cognitive function of DEACMP patients [27,28] .Relevant studies have also shown that DXM and HBO also have a good clinical effect on the recovery of cognitive function of DEACMP patients [29] .…”

Section: Introductionmentioning

confidence: 99%

Efficacy of DL-3 n-butylphthalide on psychiatric,behavioural and cognitive functions in delayed encephalopathy after acute carbon monoxide poisoning

Chen¹,

Yang²,

Li³

et al. 2020

Preprint

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Background The main hazards of carbon monoxide (CO) poisoning are its serious clinical effects,high incidence and mortality of toxicity.Acute brain injury and delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) are the most common neurological complications.CO poisoning can cause neurological,psychiatric,behavioural and cognitive disorders,including cortical blindness,parkinsonism,amnesia,personality changes,dementia,and mental disorders such as anxiety and depression.This study was performed to assess the efficacy of DL-3 n-butylphthalide (NBP) and dexamethasone (DXM) and hyperbaric oxygen (HBO) on psychiatric,behavioural and cognitive functions in DEACMP.Patients and methods A total of 179 patients with DEACMP were recruited and assigned to the combined-therapy group(receiving NBP and DXM 5 mg/day plus HBO therapy) or the control group (HBO therapy as monotherapy).The behavioural and cognitive functions in patients were evaluated by the Mini-Mental State Examination (MMSE),the Montreal cognitive assessment (MoCA) scale and the Barthel index of activities of daily living (ADL) after the treatment at 1 month,3 months,and 1 year respectively.The psychiatric changes in patients were evaluated by the Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) after the treatment at 3 months and 1 year respectively.Results At 1 month,3 months and 1 year after the treatment,the MMSE,MoCA and ADL scores were all significantly higher in the combined therapy group than those in the control group.At 3 months and 1 year after the treatment,the HAMA and HAMD scores were all significantly lower in the combined therapy group than those in the control group.There were no significant alterations in blood glucose,blood lipids,or liver or kidney function during the whole treatment session.Some patients experienced loss of appetite,mild headache and minor skin irritations.However,these patients recovered by themselves and needed no additional medications or special treatment. Conclusion These results indicated that NBP and DXM combined with HBO for the treatment of DEACMP can significantly improve the psychiatric,behavioural and cognitive functions of patients and is very safe.

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Combined application of dexamethasone and hyperbaric oxygen therapy yields better efficacy for patients with delayed encephalopathy after acute carbon monoxide poisoning

Cited by 36 publications

References 22 publications

Abnormal degree centrality in delayed encephalopathy after carbon monoxide poisoning: a resting-state fMRI study

Abnormal degree centrality in delayed encephalopathy after carbon monoxide poisoning: a resting-state fMRI study

Wallerian degeneration of bilateral cerebral peduncles after acute carbon monoxide poisoning

Efficacy of DL-3 n-butylphthalide on psychiatric,behavioural and cognitive functions in delayed encephalopathy after acute carbon monoxide poisoning

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