Combined Treatment of Methylprednisolone Pulse and Memantine Hydrochloride Prompts Recovery from Neurological Dysfunction and Cerebral Hypoperfusion in Carbon Monoxide Poisoning: A Case Report

Iwamoto, Konosuke; Ikeda, Ken; Mizumura, Sunao; Tachiki, Kazuhiro; Yanagihashi, Masaru; Iwasaki, Yasuo

doi:10.1016/j.jstrokecerebrovasdis.2013.05.014

Cited by 23 publications

(15 citation statements)

References 20 publications

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“…However, no results have been reported as to its negative effects on cognitive functions. Memantine treatment has been introduced into human therapy [15,22] but its efficacy is still a matter of discussion [14]. These findings are in agreement with the results of our earlier behavioral [10] and the present electrophysiological studies with KYNA and SZR72.…”

Section: Discussionsupporting

confidence: 91%

Paradox effects of kynurenines on LTP induction in the Wistar rat. An in vivo study

Demeter

Nagy

Farkas

et al. 2013

Neuroscience Letters

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Section: Discussionsupporting

confidence: 91%

Paradox effects of kynurenines on LTP induction in the Wistar rat. An in vivo study

Demeter

Nagy

Farkas

et al. 2013

Neuroscience Letters

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“…In particular, the relevance between ongoing inflammation and neurological sequelae after CO poisoning has been demonstrated in several studies . Treatments targeting the downstream inflammatory effect of CO poisoning have been shown to ameliorate CO‐mediated neurological sequelae in animal studies and clinical reports . .…”

Section: Introductionmentioning

confidence: 99%

The predictive value of scores based on peripheral complete blood cell count for long‐term neurological outcome in acute carbon monoxide intoxication

Moon

Chun

Cho

2018

Basic Clin Pharma Tox

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Growing evidence indicates that inflammation is associated with neurological sequelae after CO poisoning. Several scores incorporating the peripheral complete blood cell (CBC) count have been introduced as indicators of systemic inflammation. This study investigated whether these scores can improve the predictive accuracy for long-term neurological outcome of acute carbon monoxide (CO) poisoning. Two hundred seventy-nine patients who suffered from acute CO poisoning were included. Data on the demographic details, serial peripheral CBC counts and scores based on peripheral CBC counts (neutrophil-lymphocyte ratio (NLR), monocytelymphocyte ratio (MLR), platelet-lymphocyte ratio (PLR), systemic immune inflammation index [SII]) over the first 12 hours after presentation together with the clinical course during hospitalization and long-term neurological outcome were collected. Both a multivariate logistic regression model with only significant univariate predictors and a model with univariate predictors plus each score for long-term neurological outcome were constructed. Patients with a poor long-term neurological outcome had higher neutrophil and monocyte counts and lower lymphocyte counts over the first 12 hours after admission than patients with a good outcome. The diagnostic performance of the NLR, MLR and SII over the first 12 hours for predicting long-term neurological outcome was acceptable. These scores at presentation were independently associated with the long-term neurological outcome. Among these scores, only the SII at presentation significantly improved the predictive accuracy of the model when combined with clinical parameters (AUC 0.949, 95% CI 0.916-0.972 vs AUC 0.923, 95% CI 0.884-0.952 for the model with clinical parameters only, P = 0.0476). The optimal cut-off value for SII at presentation was 1012.2, resulting in a sensitivity of 97% (84.2%-99.9%) and specificity of 64.6% (58.2%-70.6%). The SII at presentation could significantly improve the prognostic accuracy for predicting the long-term neurological outcome in patients with acute CO poisoning. Because the SII is an inexpensive and easily measurable parameter, it might be used as a prognostic tool in clinical fields. K E Y W O R D S

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“…With the extensive literature survey, we understood that though CO poisoning and related complications are common, the exact mechanisms of acute and delayed toxicity, preventive methods and the suggested treatments are yet to be elucidated [29, 30]. A targeted preventive treatment of DNS during interface between acute poisoning and DNS needs to be worked out.…”

Section: Discussionmentioning

confidence: 99%

A case of delayed neurological manifestation following carbon monoxide poisoning in Sri Lanka: epidemiology of exposure and literature review

Kumarihamy

Kularatne

Pathirage

et al. 2019

BMC Pharmacol Toxicol

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Background Carbon monoxide poisoning is a common emergency worldwide, which carries high morbidity and mortality. Some patients who recover from the insult of acute carbon monoxide toxicity may later develop delayed neuropsychiatric sequelae (DNS) after a lucid period in the form of cognitive impairments, a broad spectrum of neurological deficits and affective disorders. Here, we present the first case of DNS following carbon monoxide poisoning in Sri Lanka and epidemiology of the exposure of nine (9) more victims. Case presentation A 55-year-old patient and nine other people developed effects of carbon monoxide poisoning in two different occasions after sleeping few hours in the same room in their work place in Sri Lanka. These patients developed spectrum of symptoms with the acute carbon monoxide poisoning. However, one patient developed neurological deterioration pertaining to delayed neuropsychiatric sequelae (DNS) after 1 month of lucid interval. His MRI scan of the brain showed diffuse high signal intensity involving subcortical white matter, globus pallidus on FLAIR and T2W images. These areas showed high signals in DWI images with no significant changes appreciated on ADC map. There was no abnormal contrast enhancement appreciated in the above areas. EEG showed generalized slow waves. He gradually deteriorated over next 2 weeks, exhibited athetoid movements of his feet and hands and went into rigid akinetic mute state. He could not response to any stimulation and even displayed decorticated-like posture and died. Others had normal MRI brain finding at 8 weeks of acute toxicity and all were neurologically normal after 1 year. Conclusion Though, it is uncommon in a tropical country like Sri Lanka, clinicians should have high degree of suspicion with the correct circumstances, as it is a challenge for the emergency physicians, even in countries with higher rate of CO poisoning. The exact mechanisms of acute and delayed toxicity, preventive methods and the suggested treatments are yet to be elucidated and this needs further attention and studies.

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Combined Treatment of Methylprednisolone Pulse and Memantine Hydrochloride Prompts Recovery from Neurological Dysfunction and Cerebral Hypoperfusion in Carbon Monoxide Poisoning: A Case Report

Cited by 23 publications

References 20 publications

Paradox effects of kynurenines on LTP induction in the Wistar rat. An in vivo study

Paradox effects of kynurenines on LTP induction in the Wistar rat. An in vivo study

The predictive value of scores based on peripheral complete blood cell count for long‐term neurological outcome in acute carbon monoxide intoxication

A case of delayed neurological manifestation following carbon monoxide poisoning in Sri Lanka: epidemiology of exposure and literature review

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