The usefulness of diffusion-weighted magnetic resonance imaging performed in the acute phase as an early predictor of delayed neuropsychiatric sequelae in acute carbon monoxide poisoning

Ys, Kim; Ys, Cha; Ms, Kim; Kim, Hyung Jun; Ys, Lee; Youk, Hyun; Kim, HI; oh, kim seung; Kc, Cha; Kh, Lee; Hwang, Sung Oh

doi:10.1177/0960327117722821

Cited by 17 publications

(20 citation statements)

References 32 publications

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“…In patients with CO poisoning, it was found that there was a 10-26% finding in MRI in the long term, and this rate was reported to be 14 times higher than those that developed acutely (9,(11)(12)(13) (8). In our study, neurological findings were detected in 10.4% of the patients, and MRI findings were detected in 40.6% of these patients.…”

Section: Discussionsupporting

confidence: 42%

Clinical and Magnetic Resonance Imaging Findings of Patients with Acute Carbon Monoxide Poisoning

Kavak

Doğan

Sultanoğlu

et al. 2020

Konuralp Tıp Dergisi

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We aim to evaluate the demographic and clinical characteristics of patients with acute carbon monoxide (CO) poisoning, who had a Glasgow Coma Score (GCS) below 15, and who had cerebral lesions detected in magnetic resonance imaging (MRI). Methods: The age, gender, causes of CO intoxication, clinical signs, neurological findings, GCS, blood carboxyhemoglobin level (COHb), serum pH, lactate, creatine kinase (CK), creatinine kinase-myocardial band MB (CK-MB), troponin-I level, brain MRI (T1weighted, T2-weighted, FLAIR and diffusion-weighted imaging), treatment, and mortality status of 327 patients were evaluated retrospectively. Results: The median age of patients was 31.5 years (IQR=19.5 years), 72.2% of the patients were women. Neurological findings were detected in 34 (10.4%) of the patients. The frequency of dyspnea was significantly higher in patients with neurological findings (p<0.05). The COHb and lactate levels of patients with neurological findings were found to be significantly high, the pH level was significantly lower (p<0.05). There was no significant relationship between the presence of neurological findings and CK, CK-MB, and troponin-I levels (p>0.05). Patients with neurological findings were found to have a significantly longer follow-up period, more frequently received hyperbaric oxygen therapy (p<0.05). The rate of hospitalization was 10.7%, the mortality rate was 0.9%. Hospitalization and mortality rates were significantly high in patients with neurological findings (p <0.05). Pathological findings were detected in 13 (40.6%) of 32 of patients (except for 2 patients who did not respond to the resuscitation) who had an MRI. Conclusions: It was determined that acute CO poisoning may lead to acute brain damage, 40.6% would be detected in brain MRIs taken in patients during the acute phase.

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Section: Discussionsupporting

confidence: 42%

Clinical and Magnetic Resonance Imaging Findings of Patients with Acute Carbon Monoxide Poisoning

Kavak

Doğan

Sultanoğlu

et al. 2020

Konuralp Tıp Dergisi

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“…Initial conscious disturbance is a known risk factor of DNS development [1,2,4]. However, Kim et al [5] reported that the Glasgow Coma Scale had 80% sensitivity and 77% specificity, which renders it unsuitable as a predictor in this case. Currently there are only a small number of parameters that are deemed useful in predicting DNS [6][7][8].…”

Section: Introductionmentioning

confidence: 98%

Risk factors for delayed encephalopathy following carbon monoxide poisoning: Importance of the period of inability to walk in the acute stage

Suzuki

2021

PLoS ONE

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Objective Delayed neurological sequelae (DNS) is a serious complication that occurs after acute carbon monoxide (CO) intoxication. The study identified factors for predicting DNS development for the purpose of improving CO intoxication treatment strategies. Methods The medical records of 65 patients admitted to Shizuoka Saiseikai General Hospital between 2004 and 2020 due to CO poisoning were retrospectively reviewed. Univariate and multivariate logistic regression analyses were performed, using a range of evaluated items as explanatory variables and the development of DNS as the response variable. Results Patients who developed DNS were found to have higher peak creatine kinase (CK) (odds ratio, 1.0003; 95% CI, 1.0001–1.0005; P<0.001), and experienced a greater number of days during which walking was impossible in the acute stage following intoxication (odds ratio, 1.011; 95% CI, 1.005–1.018; P<0.001) according to the univariate analysis. Multivariate analyses indicated that DNS development was related to the score, peak CK (U/L) + 40 × the number of days in which walking was impossible. The model demonstrated an area under the receiver operating characteristic curve (AUC) of 0.96 (95% CI, 0.91–1.00), and DNS was predicted with 100% sensitivity and 82% specificity. Conclusion An indicator that incorporates the number of days that walking is impossible for a patient could be useful in planning therapeutic strategies.

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“…Since MRI can diagnose brain damage from CO poisoning, DNS may be more likely to occur in patients with ABLM. Recent studies have proposed that lesions on MRI, especially on DWIs, can predict DNS [ 18 , 34 ]. However, differences in the locations or patterns of MRI lesions have not revealed any correlations with DNS [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Cerebral White Matter Lesions on Diffusion-Weighted Images and Delayed Neurological Sequelae after Carbon Monoxide Poisoning: A Prospective Observational Study

et al. 2020

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Introduction: Carbon monoxide (CO) poisoning can result in delayed neurological sequelae (DNS). Factors predicting DNS are still controversial. This study aims to determine whether acute brain lesions observed using diffusion-weighted magnetic resonance imaging (MRI) following acute CO poisoning are related to the subsequent development of DNS. Methods: This prospective study was conducted on patients with CO poisoning treated at a university hospital in Bucheon, Korea. From August 2016 to July 2019, a total of 283 patients visited the hospital because of CO poisoning. Exclusion criteria included age under 18 years, refusing hyperbaric oxygen therapy, refusing MRI, being discharged against medical advice, being lost to follow-up, having persistent neurological symptoms at discharge, and being transferred from another hospital 24 h after exposure. Results: Of the 154 patients included in the final study, acute brain lesions on MRI (ABLM) were observed in 49 patients (31.8%) and DNS occurred in 30 patients (19.5%). In a logistic regression analysis, lower Glasgow coma scale score and higher exposure time were associated with DNS, and the presence of ABLM in white matter was significantly associated with DNS (OR 6.741; 95% CI, 1.843–24.660; p = 0.004). Conclusion: The presence of ABLM in white matter was significantly related to the occurrence of DNS. Early prediction of the risk of developing DNS through MRI may be helpful in treating patients with CO poisoning.

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The usefulness of diffusion-weighted magnetic resonance imaging performed in the acute phase as an early predictor of delayed neuropsychiatric sequelae in acute carbon monoxide poisoning

Cited by 17 publications

References 32 publications

Clinical and Magnetic Resonance Imaging Findings of Patients with Acute Carbon Monoxide Poisoning

Clinical and Magnetic Resonance Imaging Findings of Patients with Acute Carbon Monoxide Poisoning

Risk factors for delayed encephalopathy following carbon monoxide poisoning: Importance of the period of inability to walk in the acute stage

Cerebral White Matter Lesions on Diffusion-Weighted Images and Delayed Neurological Sequelae after Carbon Monoxide Poisoning: A Prospective Observational Study

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