Progressive neuropsychiatric and brain abnormalities after smoke inhalation

Abstract

A 46-year-old man inhaled combustible smoke of unknown chemical composition for 15-20 min in an automobile body shop. Within 1 month, he noted headache, sadness, anergia, anhedonia, agitation, poor sleep and impairment of concentration, attention and learning skills. Three years later, mental status examination showed major depression and cognitive disorder manifested by apprehension, continuous sadness, agitation, exhaustion, difficulty with word finding, bradyphrenia, short-term and long-term memory impairment, and judgement impaired by impulsive and affect-laden reactions without reflection. Impairments were noted on neuropsychiatric tests, and positron emission tomography (PET) scan of the brain with 18 F-fluorodeoxyglucose showed globally decreased and heterogeneous metabolic activity in the entire brain. Treatment included sertraline, methylphenidate, valproic acid and topiramate. At 14 years after smoke inhalation injury, he had persistent cognitive impairment. Repeat brain PET scan showed areas of improvement and deterioration. This case shows long-term brain and psychiatric dysfunction resulting after toxic smoke inhalation, with some areas of the brain having progressive deterioration between years 3 and 14 after smoke inhalation. BACKGROUND

Post-traumatic stress disorder: A differential diagnostic consideration for COVID-19 survivors

“…Survivors of severe COVID-19 are more likely to have a history of hypoxia and resulting acquired brain injury. These have also been associated with both cognitive and psychiatric impairments (Schultz et al, 2018) and progressive brain deterioration more than a decade after the original injury (Tobe, 2012). Both persistent neurocognitive deficits and declining mental health have been observed in ARDS survivors two years after hospital discharge (Hopkins et al, 2005), and cognitive impairment has been associated with worse health-related quality of life and greater disability status in ARDS survivors (Rothenh€ ausler et al, 2001).…”

Limiting progressive hippocampal metabolic abnormalities after smoke inhalation injury

“…As previously reported, a 46-year-old man had a smoke inhalation injury that caused chronic pulmonary illness, several hospitalisations for pneumonia, and obstructive sleep apnoea 2. The pulmonary condition necessitated daily treatment with oral corticosteroids.…”

“…Quantitative comparison of 18 F-fluorodeoxyglucose positron emission tomography scans made at 3 and 14 years after injury showed significant differences in improvement or deterioration of glucose metabolism in different regions of the brain 2. Quantitative analysis of regional glucose metabolism between 3 and 14 years after the smoke inhalation injury did not support an association between regional brain connections.…”

“…In a previous report, abnormalities in glucose metabolism were noted in several brain regions in a patient who had a smoke inhalation injury 2. Further discussion of this case was performed at a grand rounds presentation, and it was hypothesised that sertraline may have provided selective hippocampal neuroprotection.…”