Bilateral Basal Ganglia Haemorrhage Secondary to Carbon Monoxide Poisoning

Ashraf Dower,Mohammad Cheik-Hussein,George Samandouras,Sophie Camp

doi:10.5171/2016.448564

Abstract

Bilateral Basal Ganglia Haemorrhage Secondary to Carbon Monoxide Poisoning

Highlights

Simultaneous bilateral intracerebral haemorrhages (ICH) are exceptionally rare and an association with carbon monoxide poisoning is yet to be described (Neau et al, 1997)
Clinical Presentation: We describe a case in which recent carbon monoxide (CO) poisoning may have been a significant predisposing factor to the development of bilateral basal ganglia haemorrhages
This is supported by neuroimaging evidence of foci of haemorrhage and necrosis occurring after CO toxicity (Bianco & Floris, 1996), as well as haemorrhagic infarcts occurring as a complication of CO exposure (Bianco & Floris, 1996; Finelli & DiMario, 2004)

Summary

Introduction

Simultaneous bilateral ICHs are exceptionally rare and an association with carbon monoxide poisoning is yet to be described (Neau et al, 1997). 19 case reports exist to date that describe an association between carbon monoxide poisoning and haemorrhagic infarction. The utilisation of decompressive craniectomy in the management of simultaneous bilateral ICH has not previously been reported. The patient had no significant past medical history, lived alone, and worked as a data analyst During their hospital stay it emerged that one month prior to admission, the patient had been fixing his boiler, when he involuntarily inhaled a large volume of released gas, carbon monoxide (CO). The patient was tachycardic (130bpm) and hypertensive (160/90mmHg) with a Glasgow Coma Scale (GCS) of 5 (E1V1M3) He was resuscitated, intubated and ventilated, and a CT head performed. This revealed bilateral basal ganglia haemorrhages (Figure 1). His brain stem reflexes were all intact, he remained quadriplegic

Discussion

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Conclusion