Abstract
Introduction: Carbon monoxide (CO) poisoning can result in delayed neurological sequelae (DNS). Factors predicting DNS are still controversial. This study aims to determine whether acute brain lesions observed using diffusion-weighted magnetic resonance imaging (MRI) following acute CO poisoning are related to the subsequent development of DNS. Methods: This prospective study was conducted on patients with CO poisoning treated at a university hospital in Bucheon, Korea. From August 2016 to July 2019, a total of 283 patients visited the hospital because of CO poisoning. Exclusion criteria included age under 18 years, refusing hyperbaric oxygen therapy, refusing MRI, being discharged against medical advice, being lost to follow-up, having persistent neurological symptoms at discharge, and being transferred from another hospital 24 h after exposure. Results: Of the 154 patients included in the final study, acute brain lesions on MRI (ABLM) were observed in 49 patients (31.8%) and DNS occurred in 30 patients (19.5%). In a logistic regression analysis, lower Glasgow coma scale score and higher exposure time were associated with DNS, and the presence of ABLM in white matter was significantly associated with DNS (OR 6.741; 95% CI, 1.843–24.660; p = 0.004). Conclusion: The presence of ABLM in white matter was significantly related to the occurrence of DNS. Early prediction of the risk of developing DNS through MRI may be helpful in treating patients with CO poisoning.
Highlights
Carbon monoxide (CO) poisoning can result in delayed neurological sequelae (DNS)
Troponin I is a diagnostic tool for assessing myocardial damage in CO poisoning but can be used as a predictor for DNS because increased troponin I indicates reduced blood supply to the brain, which can lead to neurological abnormalities [27,28]
We found that troponin I was not a predictor for DNS, perhaps because it is a component of the contractile apparatus of myocytes and is too specific to myocardial injury compared with other predictors; it may not accurately reflect pathophysiological differences related to neurological results [28]
Summary
Carbon monoxide (CO) poisoning can result in delayed neurological sequelae (DNS). Factors predicting DNS are still controversial. Carbon monoxide (CO) is a colorless, tasteless, and odorless toxic gas produced by incomplete combustion of carbon-based fuel and material [1] Because of these characteristics, patients often do not know they are affected and, in mild cases, diagnosis and treatment are often delayed because symptoms do not appear immediately. CO has 250 times greater affinity for hemoglobin (Hb) than oxygen, so it binds Hb and reduces oxygen transport This is a major cause of mortality and morbidity associated with CO poisoning because this process can damage the brain and heart, which are vulnerable to ischemia [2]. Previous studies have suggested that old age, loss of consciousness at the time of exposure, and initial neurological abnormality are predictors of DNS following acute CO poisoning, but this remains controversial [4,5]
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