Neurologic complications of carbon monoxide intoxication

Betterman, Kerstin; Patel, Surju

doi:10.1016/b978-0-7020-4087-0.00064-4

Cited by 36 publications

(33 citation statements)

References 47 publications

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“…Hyperbaric oxygenation therapy is especially advised for patients with transient or prolonged episodes of loss of consciousness, abnormal neurological signs, FIGURE 1. The electroencephalography record cardiovascular dysfunction, severe acidosis, patients who are 36 years or older, pregnant women, when exposed for more than 24 hours, or those who have COHb levels of 25% or more [4].…”

Section: Discussionmentioning

confidence: 99%

“…In the heating season 2015/2016 in Poland there were 3,878 cases of exposure to CO, with 2,229 injured and 50 deaths [3]. Neurological symptoms may be both acute and delayed, with clinical presentation depending on the severity and duration of the exposure to CO [4]. With regard to COHb concentration, different symptoms appear, such as headache, malaise, shortness of breath (10-20% COHb), vertigo, consciousness disturbaces, muscle weakness (20-30% COHb), and death within minutes (60-70% COHb) [5].…”

Section: Introductionmentioning

confidence: 99%

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Delayed neurological sequelae in carbon monoxide poisoning – a case report and present state of knowledge

Kotlęga

Peda

Gołąb-Janowska

et al. 2017

Pomeranian J Life Sci

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Introduction: Carbon monoxide (CO) is one of the most common causes of fatal gas poisoning through the airways mainly due to central heating faults. Carbon monoxide inhibits oxygen transport by binding to haemoglobin and the formation of carboxyhaemoglobin. The neuropsychological symptoms of poisoning are defined as delayed neurological sequelae and usually occur after a lucid interval. Case report: We present a patient with neurological symptoms that occurred 27 days after acute poisoning that had been treated with the use of hyperbaric oxygen therapy. On examination the patient was in a mutism-like state, had severe cognitive disorders, hypomimia, bilateral limb stiffness, increased deep tendon reflexes, bilateral Babinski sign and sphincter incontinence. The brain magnetic resonance imaging showed diffused bilateral hyperintensities in the white matter with additional lesions in semioval centres. She was treated with amantadine infusions, sertraline, levodopa and piracetam with gradual improvement. Besides neurological improvement the outcome was fatal. In our patient the initial Glasgow Coma Scale score was 7 points, and leukocytosis and troponin increase were detected. These results might be potentially used as prognostic factors in the course of the observed neurological symptoms. Conclusions: Further studies should be performed for a better understanding of delayed neurological sequelae pathogenesis aiming at the prevention or effective treatment of this significantly disabling disorder. Keywords: delayed neurological sequelae; carbon monoxide; intoxication; encephalopathy; treatment. ABSTRAKT Wstęp:Tlenek węgla (CO) jest jedną z najczęstszych przyczyn śmiertelnego zatrucia poprzez drogi oddechowe, spowodowane głównie niesprawnością urządzeń grzewczych. Tlenek węgla prowadzi do hamowania transportu tlenu przez połączenie z hemoglobiną i utworzenie karboksyhemoglobiny. Objawy neuropsychologiczne określane jako opóźnione następstwa neurologiczne zatrucia pojawiają się zwykle po okresie przejaśnienia. Opis przypadku: Objawy neurologiczne pojawiły się 27 dni po zatruciu tlenkiem węgla leczonym terapią hiperbaryczną. W badaniu stwierdzono objawy mutyzmu, znaczne zaburzenia poznawcze, hipomimię, obustronną sztywność kończyn, wzmożone odruchy głębokie, obustronnie objaw Babińskiego i nietrzymanie zwieraczy. W badaniu rezonansem magnetycznym mózgowia zaobserwowano rozlane zmiany hiperintensywne obustronnie w istocie białej i w środkach półowalnych. W leczeniu stosowano wlewy amantadyny, sertralinę, lewodopę oraz piracetam, uzyskując stopniową poprawę. Pomimo poprawy stanu neurologicznego zachorowanie skończyło się zgonem. Początkowy wynik w skali Glasgow wyniósł 7 pkt, obserwowano leukocytozę, podwyższony poziom troponiny. Wyniki te mogą być potencjalnie wykorzystane jako czynniki predykcyjne rokowania w przebiegu obserwowanych objawów neurologicznych. Wnioski: Kolejne badania powinny mieć za cel lepsze poznanie patogenezy powikłań neurologicznych w przebiegu zatrucia CO w celu prewencji i skutecznego lec...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Delayed neurological sequelae in carbon monoxide poisoning – a case report and present state of knowledge

Kotlęga

Peda

Gołąb-Janowska

et al. 2017

Pomeranian J Life Sci

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“…6,7 Psychiatric sequelae can also occur. 6,7 MRI can show hyperintensities in globus pallidus in half of the patients and in the white matter in most patients. 8 There is no approved treatment for the delayed sequelae.…”

Section: Go To Sectionmentioning

confidence: 99%

“…5 Delayed sequelae happen in 3%-40% of the intoxicated patients 2 days to 4 weeks after the exposition. 6,7 Diverse manifestations can occur: gait and motor disturbances, Parkinson-like syndromes, myoclonus, ataxia, chorea, fecal and urinary incontinence, peripheral neuropathies, recurrent headache, epilepsy, and cognitive impairment (involving memory, language, and praxis). 6,7 Psychiatric sequelae can also occur.…”

Section: Go To Sectionmentioning

confidence: 99%

“…6,7 Diverse manifestations can occur: gait and motor disturbances, Parkinson-like syndromes, myoclonus, ataxia, chorea, fecal and urinary incontinence, peripheral neuropathies, recurrent headache, epilepsy, and cognitive impairment (involving memory, language, and praxis). 6,7 Psychiatric sequelae can also occur. 6,7 MRI can show hyperintensities in globus pallidus in half of the patients and in the white matter in most patients.…”

Section: Go To Sectionmentioning

confidence: 99%

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Clinical Reasoning: A 55-year-old man with rapidly progressive dementia and parkinsonism

2017

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A 55-year-old right-handed man presented with a history of rapidly progressive apathy and behavior changes, speech loss, bladder and bowel incontinence, and gait loss in the previous month. He had been diagnosed with depression 7 months before and tried to commit suicide with carbon monoxide poisoning 2 months before, needing treatment in a hyperbaric chamber, with a good recovery. He had no history of other comorbidities and an unremarkable family history. At the first neurologic evaluation at our department, he presented with marked apathy and mutism, pseudobulbar affect, marked frontal release signs, generalized rigidity with hypomimia, global hyperreflexia with a left extensor plantar reflex, infrequent generalized myoclonus, and gait apraxia. Basic laboratory tests including electrolytes, complete blood count, carboxyhemoglobin, and liver function tests and CT scan had normal results. He had been medicated with lorazepam and mirtazapine but abandoned medication 2 weeks after the suicide attempt. He denied drug use or substantial alcohol consumption.Questions for consideration:

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Kreislaufstillstand unter besonderen Umständen

Lott

Truhlář

Alfonzo

et al. 2021

Notfall Rettungsmed

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Diese Leitlinien des European Resuscitation Council (ERC) für den Kreislaufstillstand unter besonderen Umständen basieren auf dem 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. Dieses Kapitel enthält Leitlinien zu den Modifikationen der lebensrettenden Basismaßnahmen und erweiterten lebensrettenden Maßnahmen zur Vorbeugung und Behandlung von Kreislaufstillständen unter besonderen Umständen; insbesondere spezielle Ursachen (Hypoxie, Trauma, Anaphylaxie, Sepsis, Hypo‑/Hyperkaliämie und andere Elektrolytstörungen, Hypothermie, Lawinengeschehen, Hyperthermie und maligne Hyperthermie, Lungenembolie, Koronarthrombose, Herzbeuteltamponade, Spannungspneumothorax, Giftstoffe), spezielle Umstände (Operationssaal, Herzchirurgie, Herzkatheterlabor, Dialyseeinheit, Zahnkliniken, Transport während des Flugs, Kreuzfahrtschiffe, Sport, Ertrinken, Großschadensereignisse) und spezielle Patientengruppen (Asthma und chronisch obstruktive Lungenerkrankung, neurologische Erkrankungen, krankhafte Adipositas, Schwangerschaft). Zusatzmaterial online Die Online-Version dieses Beitrags (10.1007/s10049-021-00891-z) enthält das originale Zusatzmaterial aus dem Artikel in Resuscitation. Beitrag und Zusatzmaterial stehen Ihnen auf www.springermedizin.de zur Verfügung. Bitte geben Sie dort den Beitragstitel in die Suche ein, das Zusatzmaterial finden Sie beim Beitrag unter „Ergänzende Inhalte“.

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Neurologic complications of carbon monoxide intoxication

Cited by 36 publications

References 47 publications

Delayed neurological sequelae in carbon monoxide poisoning – a case report and present state of knowledge

Delayed neurological sequelae in carbon monoxide poisoning – a case report and present state of knowledge

Clinical Reasoning: A 55-year-old man with rapidly progressive dementia and parkinsonism

Kreislaufstillstand unter besonderen Umständen

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