Sciatic neuropathy and rhabdomyolysis after carbon monoxide intoxication

Abstract

Rationale:Peripheral neuropathy is a rare complication of carbon monoxide intoxication. Peripheral neuropathy following carbon monoxide intoxication is known to completely recover within a few months.Patient concerns:A 40-year-old man complained of motor weakness and hypoesthesia of the right lower extremity with swelling of his right thigh after carbon monoxide intoxication resulting from a suicide attempt.Diagnoses:Following nerve conduction and electromyographic studies, the patient was diagnosed with sciatic neuropathy with severe axonopathy. Clinical and laboratory findings led to a diagnosis of rhabdomyolysis.Interventions:The patient was treated conservatively for rhabdomyolysis and underwent comprehensive rehabilitation for sciatic neuropathy during hospitalization.Outcomes:After discharge, he underwent serial follow-up tests with nerve conduction and electromyographic studies, which showed prolonged persistence of sciatic neuropathy; however, he showed significant improvement at his 26-month post-discharge follow-up.Lesson:Patients presenting with peripheral neuropathy secondary to carbon monoxide intoxication may show variable recovery periods; however, a favorable prognosis can be expected regardless of the concomitant occurrence of rhabdomyolysis and/or compartment syndrome.

Gluteal compartment syndrome secondary to prolonged immobilization following carbon monoxide poisoning associated with leukoencephalopathy: A case report

“…Atraumatic gluteal compartment syndrome (GCS) is rare occurrence, it is hypothesized that prolonged pressure due to resting on hard uneven surfaces in an unusual position can lead to gluteal muscles swelling and edema, resulting in increased intra-compartmental pressure [ 22 ]. This can occur in multiple conditions where the patient consciousness or orientation has been altered, such as drug abuse, alcohol intoxication, carbon monoxide poisoning, and surgical positioning [ 10 , [15] , [16] , [17] , [18] , 23 ]. Due to the large muscle mass GCS is frequently accompanied by crush syndrome, which describes systemic manifestations of rhabdomyolysis and multiple organ failure alongside compartment syndrome [ 3 , 11 , 12 , 14 , 24 , 25 ].…”

“…It usually leads to local muscle swelling, which may be the cause of increased the intra-compartmental pressure. This in turn will cause tissue hypo-perfusion and muscle necrosis and eventually rhabdomyolysis occurs, and patient might develop acute renal failure [ 17 , 18 ]. Peripheral neuropathy is a rare associated complication, and its prevalence has been reported to be 0.84% in 2360 patients diagnosed with Carbon monoxide intoxication [ 32 ].…”

“…Carbon monoxide-induced rhabdomyolysis leading to compartment syndrome in the buttocks is rare, with few cases reported in the literature [ [35] , [36] , [37] ]. Due to its highly deleterious effects, our brain tissue is sensitive to carbon monoxide toxicity.…”

“…Gluteal compartment syndrome (GCS) is a rare diagnosis and results mostly from a non-traumatic case such as prolonged surgery, substance abuse, or drug overdose [ [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] ]. Carbon monoxide poisoning as a cause of gluteal compartment syndrome is rarely reported in the literature [ 17 , 18 ]. We present an interesting case of a gluteal compartment syndrome, complicated with sciatic nerve palsy, caused by prolonged immobilization due to carbon monoxide poisoning associated with sequala of leukoencephalopathy changes.…”

Pressure Necrosis Requiring Fasciotomy After Kratom Overdose

“…Rhabdomyolysis is not generally associated with Kratom use, but there are numerous reports of opioids, sedativehypnotics, ethanol, and carbon monoxide resulting in prolonged periods of immobilization with rhabdomyolysis caused by pressure necrosis. [6][7][8][9][10] In a case series of 30 patients found down after opioid overdose, the authors suggested poor function on presentation did not improve despite fasciotomy. 11 Our case suggests the sedative effects of Kratom because of its action on the mu-receptor resulted in a similar case of pressure necrosis and compartment syndrome.…”