Bilateral brachial plexus injury following acute carbon monoxide poisoning

Abstract

BackgroundCarbon monoxide (CO) intoxication is a leading cause of severe neuropsychological impairments. Peripheral nerve injury has rarely been reported. It consists usually in a demyelinating polyneuropathy or mononeuropathy affecting mainly the lower limbs. Isolated involvement of both upper extremities has been described in only 4 patients related to root damage. We report the first case of bilateral brachial plexus injury following CO poisoning and review all previous CO-induced neuropathy described in literature.Case presentationAfter being unconscious for three hours, a 42 years old man experienced bilateral brachial weakness associated with edema of the face and the upper limbs. Neurological examination showed a brachial diplegia, distal vibratory, thermic and algic hypoesthesia, deep tendon areflexia in upper limbs. There was no sensory or motor deficit in lower extremities. No cognitive disturbances were detected. Creatine kinase was elevated. Electroneuromyogram patterns were compatible with the diagnosis of bilateral C5 D1 brachial axonal plexus injury predominant on the left side. Clinical course after hyperbaric oxygen therapy was marked by a complete recovery of neurological disorders.ConclusionPeripheral neuropathy is an unusual complication of CO intoxication. Bilateral brachial plexus impairment is exceptional. Various mechanisms have been implicated including nerve compression secondary to rhabdomyolysis, nerve ischemia due to hypoxia and direct nerve toxicity of carbon monoxide. Prognosis is commonly excellent without any sequelae.

Verzögerte Kohlenmonoxidenzephalopathie

“…Dennoch wurde in einigen Fallserien beschrieben, dass Neuropathien, Plexopathien oder Radikulopathien durchaus vorkommen können. [27]. Elektroneurographisch und histologisch handelt es sich dabei meist um demyelinisierende Neuropathien.…”

Sciatic neuropathy and rhabdomyolysis after carbon monoxide intoxication

“…[ 2 , 4 ] Choi [ 5 ] suggested that peripheral neuropathy is usually associated with local swelling secondary to muscle necrosis, which is an important factor contributing to the development of peripheral neuropathy after carbon monoxide intoxication. Rahmani et al [ 6 ] reported bilateral brachial plexus injury after carbon monoxide intoxication after failed use of a water heater. They attributed the bilateral plexopathy to a combination of ischemic and toxic factors.…”

“…Despite the occurrence of local swelling in 10 of these 20 patients and the occurrence of delayed neurological sequelae in 3 of 20 patients, complete recovery was achieved within 3 to 6 months in all patients. The patient reported by Rahmani et al, [ 6 ] who had been diagnosed with bilateral brachial plexus injury after carbon monoxide intoxication, was observed to recover without any sequelae within 4 months. Choi and Lim [ 15 ] reported a patient with peripheral neuropathy involving the bilateral lower extremities after carbon monoxide intoxication who did not develop local swelling.…”

Motor and Sensory Peripheral Neuropathy in a Patient Came after Acute Carbon Monoxide Intoxication: a Case Report with Magnetic Resonance Image

“…Direct signs of peripheral neuropathy are the changes of affected nerve itself, such as changes in signal intensity particularly high signal intensity on T2WI, variable but contrast enhancement in usual, increased diameter of nerve by swelling, morphologic distortion, etc. Indirect sign of involved muscle is characterized by increased muscle signal intensity on fluid-sensitive MR sequences as a result of acute or subacute denervation edema, which also may be an important contributing factor to the development of neuropathy (5). Sequentially the affected muscle may reveals increased signal intensity on T1WI with decreased volume due to fatty atrophic change (7,8).…”

“…Another case report of bilateral brachial plexus injury following acute CO intoxication by Rahmani et al (5) 42 years old male who showed a brachial diplegia and hypoesthesia had complete recovery of neurological disorders. On the other hand, Jeong et al (6) reported a case of bilateral femoral neuropathy after CO intoxication which showed persisted neuropathy with minor improvement.…”