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

Abstract

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.

Occupational and domestic exposure associations with cerebral small vessel disease and vascular dementia: A systematic review and meta‐analysis

“…Exposures included carbon monoxide (29 studies, n = 1,409; 28 studies/ n = 1,373 in meta‐analysis), 15–43 carbon disulfide (4 studies, n = 797; 3 studies/ n = 131 in meta‐analysis), 44–47 1,2‐dichloroethane (4 studies, n = 40, n = 40 in meta‐analysis), 48–51 toluene (4 studies, n = 64/ n = 64 in meta‐analysis), 52–55 diving (4 studies, n = 266; 4 studies/ n = 172 in meta‐analysis), 56–59 high altitude (11 studies, n = 950; 5 studies/ n = 164 in meta‐analysis), 60–70 contact sports (3 studies, n = 629; not meta‐analyzable), 71–73 lead (2 studies, n = 423, not meta‐analyzable), 74,75 military (10 studies, n = 18,893, not meta‐analyzable), 76–85 pesticides/fertilizers (1 study, n = 8623, not meta‐analyzable), 86 miscellaneous solvents (4 studies, n = 251, not meta‐analyzable), 87–90 and broad occupational categories in population‐based dementia studies (9 studies, n = 15,118, not meta‐analyzable) 91–99 …”

Early neuroimaging and delayed neurological sequelae in carbon monoxide poisoning: a systematic review and meta-analysis

“…Prominent and bright signal changes in abnormal lesions are evident on MRI, reflecting a series of damage caused by COP-induced ischemic changes. Additionally, the morphology, asymmetry, and location of the lesion must be determined 16 , 26 . Previous studies demonstrated that the globus pallidus structure represents the best area to observe abnormalities in patients with acute COP 5 , 27 , 28 .…”

A Graph Theory Study of Resting‐State Functional MRI Connectivity in Children With Carbon Monoxide Poisoning

“…Positive lesions in routine MRI scanning can be found in CO poisoning patients with severe brain injury, such as abnormally high signals on the DWI sequence, and research suggests that such patients often have a poor prognosis 10 . To verify that patients who did not find lesions on routine MRI images also had changes in functional brain networks, we organized three neurologists (W.Z., 30 years of research experience; H.Z., 10 years of research experience; G.Z., 7 years of research experience) to confirm the routine MRI images of all patients through visual examinations and excluded patients who found positive lesions, and repeated the network analysis with the remaining patients.…”

“…Routine MRI is the preferred examination method for detecting brain injury after CO poisoning and has the advantages of being noninvasive and convenient, but it has certain limitations in detecting and quantifying microscopic lesions in the brain and reflecting the severity and prognosis of the disease 10 . Resting‐state MRI (fMRI) indirectly reflects the activity of brain regions and blood oxygen level‐dependent (BOLD) signal fluctuations 11 .…”

“…Routine MRI is the preferred examination method for detecting brain injury after CO poisoning and has the advantages of being noninvasive and convenient, but it has certain limitations in detecting and quantifying microscopic lesions in the brain and reflecting the severity and prognosis of the disease. 10 Resting-state MRI (fMRI) indirectly reflects the activity of brain regions and blood oxygen level-dependent (BOLD) signal fluctuations. 11 Graph theory, in particular, provides a powerful mathematical framework to simulate paired communication between network elements, allowing to identify multiple topological characteristics in the brain functional network, including Small-worldness, 12 High modularity 13 and Rich club.…”