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

Abstract

Background: Carbon monoxide (CO) is a common cause of poisoning, and its sequelae include a progressive (25%) and a delayed relapsing form (75%). We report the diffusion-weighted MRI (DWI) findings in the delayed relapsing form of CO poisoning and characterize the types of edema. Methods: From November 1, 2000 to June 1, 2003, 5 consecutive patients (2 men, 3 women, range of age: 54–67 years), who had the delayed relapsing type of CO poisoning, underwent DWI, conventional MRI, MR angiography and SPECT. CO poisoning was diagnosed by the presence of a typical clinical history, an abnormally increased level of serum carboxyhemoglobin and MRI findings. Apparent diffusion coefficient (ADC) values were measured in all of the abnormal lesions with visual inspection of DWI and T₂-weighted echo-planar imaging. Results: DWI showed high signal intensities in bilateral periventricular white matter, in the splenium of the corpus callosum, in internal capsules, and brainstem showing moderately decreased ADC values. In the globus pallidus, the ADC values were rather increased with low signal intensities on DWI. Brain SPECT showed decreased perfusion in bilateral white matter and some parts of the cerebral cortex, which correlated well with the DWI findings. Conclusions: We suggest that prominent, symmetric restricted diffusion can occur in periventricular white matter, brainstem, and corpus callosum after the delayed relapsing type of CO poisoning. Delayed cytotoxic edema can occur in this setting, which provides a new guidance for the pathogenesis of CO poisoning and the differential diagnosis of white matter diseases.

A Prospective Cohort Study on Sustained Effects of Low-Dose Ecstasy Use on the Brain in New Ecstasy Users

“…It is difficult to determine the time course of change in ADC. For stroke, transition from decreasing to increasing ADC values seems to occur between 18 h and 7 days after stroke onset (Copen et al, 2001), while delayed cytotoxic edema with restricted ADCs was described up to 6 months, after carbon monoxide poisoning (Murata et al, 2001;Chu et al, 2004), and heroin abuse (Chen et al, 2000). Only one article was published with ADC measurements in heavy ecstasy users, and showed increased ADC values in the globus pallidus (Reneman et al, 2001b).…”

Neuroimaging Studies in Carbon Monoxide Intoxication

“…Hypoperfusion (Sesay, Bidabe et al 1996;Watanabe, Nohara et al 2002;Chu, Jung et al 2004) and hypoxia (Opeskin and Drummer 1994) still play an important role. Demyelination (Murata, Kimura et al 2001;Kamijo, Soma et al 2007;Ide and Kamijo 2008), cytotoxic edema (Kim, Chang et al 2003;Chu, Jung et al 2004;Kwon, Chung et al 2004), hemorrhage (Ramsey 2001) and infarction (Schwartz, Hennerici et al 1985;Sung, Yu et al 2010) have also been associated with delayed neurological deficits. Hypoperfusion and cytotoxic edema in delayed CNS injury have been noted in WM areas and the cerebral cortex (Chu, Jung et al 2004), and ischemia and necrosis have been noted in the globus pallidus (Chang, Han et al 1992).…”

“…Demyelination (Murata, Kimura et al 2001;Kamijo, Soma et al 2007;Ide and Kamijo 2008), cytotoxic edema (Kim, Chang et al 2003;Chu, Jung et al 2004;Kwon, Chung et al 2004), hemorrhage (Ramsey 2001) and infarction (Schwartz, Hennerici et al 1985;Sung, Yu et al 2010) have also been associated with delayed neurological deficits. Hypoperfusion and cytotoxic edema in delayed CNS injury have been noted in WM areas and the cerebral cortex (Chu, Jung et al 2004), and ischemia and necrosis have been noted in the globus pallidus (Chang, Han et al 1992). Although demyelination and axonal damage might co-exist in CO intoxication, demyelination more than axonal damage is suggested in the literature (Chang, Han et al 1992;Murata, Kimura et al 2001;Kamijo, Soma et al 2007;Ide and Kamijo 2008).…”

“…Low density GP lesions, commonly seen in computed tomography (CT), are considered as characteristic findings in patients with CO intoxication (Kanaya, Imaizumi et al 1992;Gotoh, Kuyama et al 1993;Uchino, Hasuo et al 1994;Chu, Jung et al 2004;Kinoshita, Sugihara et al 2005;Hopkins, Fearing et al 2006). Low density lesions of the putamen and caudate nucleus, in contrast, have only been reported in one case (Ferrier, Wallace et al 1994).…”

“…Low density lesions of the putamen and caudate nucleus, in contrast, have only been reported in one case (Ferrier, Wallace et al 1994). The nature of GP lesions has been studied further by diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) mapping (Chu, Jung et al 2004;Kinoshita, Sugihara et al 2005). One case report interpreted low ADC values and high intensity GP lesions on DWI as restriction of water diffusion (i.e.…”