Delayed neurological deterioration following carbon monoxide poisoning: MRI findings

Abstract

We present two patients with delayed neurological deterioration following apparent recovery from carbon monoxide poisoning in whom magnetic resonance imaging showed abnormalities. In the first patient, cortical grey matter abnormalities were seen without white matter changes. Visual evoked potentials were, however, abnormal. In the second, diffuse white matter lesions were detected. In neither patient were basal ganglia lesions seen.

Diffusion-Weighted MRI and ^99mTc-HMPAO SPECT in Delayed Relapsing Type of Carbon Monoxide Poisoning: Evidence of Delayed Cytotoxic Edema

“…All of these lesions were symmetrical. The lesion distribution pattern of our cases was similar to the previous MRI-confirmed cases in the chronic phase of CO poisoning (table 3) [2, 18, 23, 24, 25, 26, 27, 28, 29, 30]. …”

Carbon monoxide poisoning

“…Although globus pallidus lesions are not pathognomonic for CO poisoning and may be seen in other intoxications, such as methanol or hydrogen sulfide poisoning, their presence should alert the clinician to the possibility of CO exposure. MRI in patients in patients with CO exposure may show diffuse, symmetric white matter lesions, predominantly in the periventricular areas, although the centrum semiovale, deep subcortical white matter, thalamus, basal ganglia, and hippocampus also may be affected [137,[168][169][170]. Patients with abnormal neuroimaging findings are more likely to have poorer outcomes, such as death or persistent functional neurologic impairment, after CO exposure than patients with normal neuroimaging studies [99,100,102,132,137,169].…”

Uncommon MRI and Echocardiographic Findings in a Patient of Carbon Monoxide Poisoning

“…The reason for development of this lesion has been linked to decrease in local low blood flow to the globus pallidus [17], metabolic acidosis, and hypotension in animal models. Globus pallidus lesions may be delayed for several days after presentation and may resolve gradually [18]. Sometimes associated white matter lesions may also be present [16].…”