Carbon monoxide intoxication has long been one of the most serious public health problems in Korea. This is mainly due to the wide use of anthracite coal briquettes as domestic fuel for cooking and under-the floor heating. One hundred and seven cases of CO intoxicated children hospitalized at Yonsei Medical center from January 1970 to December 1986 have been investigated clinically. The sex ratio was 1.3:1 (male 60 cases, female 47 cases) with the peak incidence occuring in patients between 12 and 14 years of age (28%). The most common symptoms were vomiting convulsions and headache; and the most frequent signs were altered mental state, increased deep tendon reflex and a positive Babinski sign. The outcome of patients was as follows: 4 cases (3.7%) expired, 77 cases (72.0%) recovered without neurologic sequelae and 26 cases (24.3%) survived with neurologic sequelae. The neurologic sequelae included persistent convulsions (7 cases), cortical blindness (3 cases), peripheral neuropathy (2 cases) and delayed neurologic sequelae (11 cases). Neurologic sequelae occurred most frequently in comatose patients (45.5%) and least often in mentally alert patients (6.1%), more frequently m patients exposed to CO gas for more than 8 hours than in those exposed for less than 8 hours, and in patients who did not receive hyperbaric oxyen therapy(29.4%) than in those who did(19.6%). Delayed neurologic sequelae were mental retardation (72.7%), epilepsy (36.4%), mutism (18.2%) etc. The lucid interval in 11 cases of delayed neurologic sequelae ranged from 2 to 20 days. The results of this study suggest that every patient exposed to CO gas should receive prompt and efficient oxygenation including hyperbaric oxygen therapy and that expeditious reduction of cerebral edema maybe of value. The importance of providing follow-up facilities in anticipation of a relapse of the delayed neurologic sequelae has been established.
Adolescent ; Carbon Monoxide Poisoning/complications* ; Carbon Monoxide Poisoning/radiography ; Carbon Monoxide Poisoning/therapy ; Central Nervous System Diseases/chemically induced* ; Child ; Child, Preschool ; Female ; Human ; Hyperbaric Oxygenation ; Male ; Tomography, X-Ray Computed

The clinical cases of 6 patients suffering with chorea after acute carbon monoxide (CO) poisoning were reviewed. There were 2 men and 4 women, and the age at onset ranged from 11 to 60 (mean 33.0) years. All the patients except one were associated with mild delayed CO encephalopathy. The latency period between CO poisoning and the onset of chorea was 10 to 30 (mean 21.7) days. The duration of chorea after CO poisoning was 14 to 90 (mean 39.8) days. The brain CT findings were bilateral low- density lesions in the basal ganglia and/or in the white matter of the cerebral cortex, and there was no correlation between the lesion sites on the imagings and the development of chorea. Neuroleptic agents alleviated the chorea and the patients did not relapse after neuroleptic agents were halted.
Acute Disease ; Adolescent ; Adult ; Brain Diseases/etiology/radiography ; Carbon Monoxide Poisoning/*complications/radiography ; Chorea/*etiology/radiography ; Female ; Human ; Male ; Middle Aged ; Tomography, X-Ray Computed

Of 129 patients with carbon monoxide (CO) poisoning, 62(48.0%) had characteristic computed tomographic (CT) findings. The most common finding, seen in 42 patients, was low-density in the cerebral white matter, and the second characteristic feature, seen in 33 patients, was low-density in both globus pallidi. Abnormal CT findings tended to increase in accordance with the duration of unconsciousness during acute CO poisoning, but such findings occurred even when the mental state was clear during acute illness. The prognosis of acute CO poisoning depended on low-density lesions of the cerebral white matter rather than those of the globus pallidus. There also seemed to be a significant correlation between the cerebral white matter changes in the initial CT scan and the development of delayed neurologic sequelae after acute CO poisoning, particularly in middle age or older patients, but no correlation between the CT findings and the clinical outcome of delayed neurologic sequelae.
Acute Disease ; Adolescent ; Adult ; Aged ; Brain/*radiography ; Carbon Monoxide Poisoning/*radiography ; Child ; Child, Preschool ; Humans ; Infant ; Middle Aged ; *Tomography, X-Ray Computed

Of 32 cases suffering from acute carbon monoxide (CO) poisoning brainstem auditory evoked potential (BAEP) abnormalities were exhibited in 8 cases. the abnormalities of BAEPs could be divided into two patterns: a peripheral pattern (6 cases) of prolongation of latency to wave 1 without prolongation of interpeak latency, and a central pattern (2 cases) of prolongation of latencies to all waves and interpeak latencies. The indicence of BAEP abnormality tended to increase in accordance with an unconscious duration of more than 24 hours; during acute CO poisoning. A BAEP abnormality exhibiting a peripheral pattern usually returned to normal within one month after anoxia, but cases showing central pattern of BAEP abnormality died during acute anoxic insult due to the possible involvement of the brainstem. Thus, BAEPs can be used for evaluating the functional intergrity of the auditory pathways and for providing prognostic values in acute CO poisoning.
Acute Disease ; Adolescent ; Adult ; Aged ; Basal Ganglia/radiography ; Brain Stem/physiopathology* ; Carbon Monoxide Poisoning/physiopathology* ; Evoked Potentials, Auditory* ; Female ; Human ; Male ; Middle Age ; Tomography, X-Ray Computed

A 59-year-old man with a history of major depression was found by his wife to be unconscious and foaming at the mouth. On arrival at the emergency department, the patient was noted to be unresponsive. Computed tomography of the brain showed symmetrical ill-defined areas of hypoattenuation involving the medial aspects of both lentiform nuclei, while magnetic resonance images of the brain showed symmetrical increased signal in the bilateral globi pallidi on diffusion weighted, T2-weighted and fluid attenuated inversion recovery sequences. These findings were those of acute carbon monoxide poisoning. Despite aggressive treatment, the patient's condition continued to deteriorate and he eventually passed away. The various imaging findings of carbon monoxide poisoning in the brain and the differential diagnoses are discussed.
Brain ; diagnostic imaging ; Carbon Monoxide Poisoning ; diagnosis ; diagnostic imaging ; Depressive Disorder, Major ; complications ; Diagnostic Imaging ; Fatal Outcome ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pulmonary Edema ; pathology ; Radiography, Thoracic ; Suicide, Attempted ; Tomography, X-Ray Computed

The regional cerebral blood flow of four patients with delayed carbon monoxide sequelae and four age matched controls was measured, using a xenon inhalation CT scan (GE 9800). Variable patterns of decreased cerebral blood perfusion according to the clinical state of the patient were noted among the patients. Follow up studies, 2 months later, indicated that there was a correlation between the fluctuation of symptoms and the changes in regional cerebral blood flow. It is suggested that the impairment of cerebral perfusion may play a critical role in delayed carbon monoxide sequelae.
Administration, Inhalation ; Aged ; Brain/*blood supply ; Brain Ischemia/chemically induced/physiopathology/*radiography ; Carbon Monoxide Poisoning/*complications ; Case Report ; Female ; Human ; Male ; Middle Age ; Regional Blood Flow/drug effects ; Support, Non-U.S. Gov't ; Time Factors ; Tomography, X-Ray Computed ; Xenon/administration and dosage/diagnostic use