Delayed Neurological Sequelae Following Carbon Monoxide Poisoning and Skin Graft: A Case Report

Reza Bidaki,Azadeh Rahavi,Maryam Khorasani,Farzaneh Dehghani,Mohamad Ebrahim Ghanei,Najmeh Zaer-Alhosseini

doi:10.34172/hpr.2020.30

Abstract

Introduction: Carbon monoxide (CO) poisoning is a prevalent lethal condition. The clinical feature of this type of poisoning varies from headache and nausea to more severe conditions. After recovery from the acute intoxication, neurological or behavioral problems may emerge. In 3%-40% of cases, delayed neuropsychiatric syndrome (DNS) in post CO poisoning, generally develops within few weeks after a preliminary remission from acute poisoning. Case Presentation: We report a patient with relatively suitable premorbid. He was admitted to the hospital with fire burning, co poisoning and discharged home with good general conditions and mental status by receiving normal baric oxygen 100%. later in post-operative management of skin graft he developed a fulminant neurological deficit by impaired memory and concentration, loosening of association, disorientation to place, time and person, agitation, aggression, mood labiality, urinary incontinency and encopresis, slow psychomotor retardation, false and approximate answers to questions, auditory and visual hallucination, staring and inappropriate laughing. As the patient was not responsive to neurological treatment, he was referred to psychiatric service. DNS in this patient resolved gradually during a short period of psychopharmacotherapy and supportive psychotherapy. Conclusion: CO poisoning may lead to neuropsychiatric sequel and neuroimaging changes which could be reversible.

Highlights

Carbon monoxide (CO) poisoning is a prevalent lethal condition
The clinical feature of CO poisoning varies from headache and nausea to more severe conditions consist of lethargy, loss of consciousness, seizure and death.[4,5]
After recovery from acute intoxication, neurological behavioral manifestation may emerge in form of Delayed neuropsychiatric syndrome (DNS)

Summary

Introduction

Carbon monoxide (CO) poisoning is a prevalent threatening status.[1,2] Carbon derived fuel is the most common source for Iranian to supply home heating during winter.[3]. DNS generally develops within a few weeks after a preliminary remission of acute poisoning in 3%-40% of cases.[6,7] Contemporary treatment for patients with acute CO poisoning is 100 percent normobaric oxygen or hyperbaric-oxygen therapy (HBO2).[4] there is no well-established treatment for CO-associated DNS.[8] This signifies a need to find efficient treatment for this devastating condition. In parallel with atrial blood gas (ABG) data (Table 1), the diagnosis of CO poisoning was highly probable and normal baric oxygen 100% administered straight away He gradually could obtain his normal status as burns management and serum therapy were running during 2 days of hospitalization. Through diagnosis of DNS induced by CO poisoning, the patient received normobaric oxygen therapy; because of psychotic symptoms we ordered Haloperidol 0.5 mg II BID, and in order to improve memory function we prescribed memantine and piracetam.

Discussion

Conclusion