Abstract
IntroductionPredictive markers for long-term outcome in carbon monoxide-intoxicated patients with late encephalopathy are desired. Here we present the first data demonstrating a full reversibility pattern of specific brain substances measured by cerebral proton magnetic resonance spectroscopy in a carbon monoxide-intoxicated victim. This may provide clinicians with important information when estimating patient outcome.Case presentationWe report the case of a 40-year-old Caucasian woman with severe carbon monoxide poisoning who was treated with five repetitive sessions of hyperbaric oxygen therapy in a multiplace chamber (100 percent oxygen with a ventilator, 90 minutes exposure to 2.8 atmospheres absolute). Initially, our patient recovered completely after three days of hospitalization, but became encephalopathic after a lucid interval of four weeks. An examination of the brain with cerebral proton magnetic resonance spectroscopy showed a dramatically decrease in N-acetylaspartate to total creatine ratios and elevated lactate levels in the gray matter. Subsequently, our patient received six additional sessions of hyperbaric oxygen therapy with only minimal recovery. At six-month follow-up our patient showed significant improvement in cognition and neuromuscular coordination. Extraordinarily, the cerebral proton magnetic resonance spectroscopy measurements at relapse compared to measurements at follow-up (217 days post insult) revealed full reversal of the severe abnormalities in mid-occipital gray matter and partial reversal in white matter.ConclusionsThe present case indicates that cerebral proton magnetic spectroscopy provides valuable information on brain metabolism in patients presenting with delayed encephalopathy after acute carbon monoxide intoxication. The full reversal of N-acetylaspartate to total creatine ratios in gray matter has, to our knowledge, never been described before and shows that severe, initial measurements may not predict poor long-term patient outcome.
Highlights
Predictive markers for long-term outcome in carbon monoxide-intoxicated patients with late encephalopathy are desired
The present case indicates that cerebral proton magnetic spectroscopy provides valuable information on brain metabolism in patients presenting with delayed encephalopathy after acute carbon monoxide intoxication
To provide additional information on the effects of Carbon monoxide (CO) on the central nervous system and its correlation to magnetic resonance spectroscopy (MRS), we report the case of a patient with delayed encephalopathy after acute CO poisoning showing an unusual reversibility pattern when measured by MRS
Summary
This case suggests that even though MRS provides valuable information on brain metabolism in patients with delayed encephalopathy due to acute CO intoxication the prediction of long-term outcome is still complicated and even patients with severe, initial MRS measurements may show remarkable reversibility. ERD contributed to the acquisition of data, drafting of the manuscript, interpretation of the magnetic resonance spectroscopy and magnetic resonance imaging results, drafting of the figure and table and critical revision of the manuscript. VAL contributed to the drafting of the manuscript, interpretation of the magnetic resonance imaging results, drafting of the figure and critical revision of the manuscript. ECJ contributed to the acquisition of data and drafting of the manuscript including critical revision. OH contributed to the acquisition of data, data interpretation and drafting of the manuscript including critical revision. Author details 1Hyperbaric Oxygen Treatment Unit, Department of Anesthesia, Centre for Head and Orthopedics, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen DK-2100, Denmark.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
