We examined 13 patients with chronic carbon monoxide (CO) poisoning by magnetic resonance imaging (MRI); all of them had been in an explosion in a coal mine 25 years previously. Symmetrical globus pallidus lesions were observed in 12, as was degeneration of the white matter, with focal cortical atrophy. The temporal parietal and occipital lobes were usually affected, the parietooccipital region being the most frequently and extensively damaged. Of the 12 patients with white matter degeneration 7 had definitely asymmetrical cortical and subcortical lesions. There were 6 patients with dilated temporal horns, probably due to atrophy of the hippocampal gyri. A history of CO inhalation and an awareness of the typical distributions of lesions are important for recognition of the effects of CO poisoning, especially when patients are in the chronic stage.

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The brains of 34 patients at the chronic stage of acute carbon monoxide poisoning (CO poisoning) were examined using computerized tomography (CT). Ventricular and sulcal dilatations were measured quantitatively, with picture analysis of CT for the measurement of ventricular dilatation. Significant ventricular and sulcal dilatations were found in all cases of the CO group compared with age-matched controls, and bilateral low density areas in the globus pallidus were seen in 9 of the patients. There were significant correlations between duration of initial unconsciousness and the ventricular dilatation or cortical atrophy. Such dilatations were considered to be due to the cerebral damage in the acute stage.

I 14 15 16 17-25 OBSERVATION Case 1 . N., K. 46 year old manWhen he was rescued at 8 P.M., 7% hours after the explosion, he appeared unresponsive to various stimuli. The next day he began to respond t o verbal stimuli, but was markedly disoriented. He had severe amnesia, poor vocabulary, and complained of blurred vision. That day, he was H e opened his eyes but was akinetic and mute. 4.Constructional apraxia and impairment of autotopokinesis were common. 5. None of patients had Gerstmann's syndrome or aphasia.6. Extrapyramidal or pyramidal manifestations were not prominent. All these findings suggest a particular vulnerability of the occipital lobe to CO intoxication.