Carbon monoxide is colorless, oolorless, tasteless and non-irritating gas produced by the incomplete combustion of carbonaceous rnaterial. It combines with hemoglobin and displaces oxygen because the affinity of hemoglobin for carbon monoxide is two hundred times greater than oxygen. Symptoma and signs of carbon monoxide poisoning include headache, nausea, vomiting, dizziness, collapse, unconsciousness, blindness, convulsion, coma and skin lesions. Recently we have observed seven patients with carbon monoxide poisoning who expressed cutaneous syrnptoms. In this work we investigated the pathogenesis of cutaneous manifestations of carbon monoxide poisoning through clinical, histologic and electronmicroscopic study. The results are summarized as follows: 1. Mental states of the patients were comatose in two, Semicomatcse in two, stuporous in two, and drowsy in one patient. In routine laboratory tests, we observed elevated blood sugar in six, elevated sorum creatinine phosphokinase in four and abnormal findings in urinalysis in all patients. 2. Cutaneous lesions were vesicobullae, plaque or swelling, erythema, gangrene and 'ulceration in order of frequency and located in the dependent areas in six caies. 3. Histopathologically, the sites of the bullae were subepidermal in four cases and intraepidermal in. one case and there was one case with ulceration. 4. In electronmicroscopic findings, secretory and ductal cells showed degenerative
Blindness ; Blood Glucose ; Carbon Monoxide Poisoning* ; Carbon Monoxide* ; Carbon* ; Coma ; Creatinine ; Dizziness ; Erythema ; Gangrene ; Headache ; Humans ; Nausea ; Oxygen ; Seizures ; Skin ; Stupor ; Ulcer ; Unconsciousness ; Urinalysis ; Vomiting

Background ; Carbon Monoxide is colorless, ordorless, highly toxic gas produced by fire and by motor vehicles and appliances which use carbon-based fuels. In Korea, since coals were the main domestic fuel for cooking and for heating the floor, many cases of carbon monoxide intoxication have occurred annually. Until now, systemic complications & clinical manifestations as well as neurologic complications following carbon monoxide poisoning have rarely been reported. METHODS: I have researched systemic complications and clinical manifestations including neurologic complications from 1986 to 1997. I reviewed retrospectively medical records of 188 admitted patients to the Yonsei Medical Center due to carbon monoxide intoxication, and analyzed them according to the neurological, cardiovascular, respiratory, urogenital, dermatological and other systems. RESULTS: 1)The number of the admitted patients due to CO intoxication to Yonsei Medical Center between 1986 and 1997 has decreased compared to that between 1976 and 1981. 2)In this study, the cause of CO intoxication were furnaces in 170 cases(93.9%), fire accidents in 2 cases(1.1%), gas boilers in 2 cases(1.1%), LPG gas in 1 case(0.55%) and propan gas in 1 case(0.55%) in order. 3)Systemic complications and clinical manifestations after CO intoxication were 167(88.8%) nervous , 59(31.4%) musculoskeletal, 56(29.8%) respiratory, 49(26%) dermatologic, 44(23.4%) cardiovascular, 30(16.0%) genitourinary and 9(4.8%) other complications. Other systemic complications as well as neurological complications were not rare. 4)The clinical manifestations of neurological complications were decreased mental status(drowsy in 57 cases(30.3%), stupor in 63 cases(33.5%), semicoma in 33 cases(17.6%), coma in 13 cases(6.9%), alert in 22 cases(11.7%), focal sign related to the stroke in 16 cases (7.4%), incontinence in 22 cases(11.7%), seizure in 4 cases(2.4%), psychiatric behavior in 4 cases(2.4%), peripheral neuropathy in 4 cases(2.4%), bracheal plexopathy in 4 cases(2.4%), and torticollis in 1 case(0.5%). Delayed neurologic sequelae were akinetic mutism in 13 cases(76.5%), mental deterioration in 6 cases(35.3%), incontinence in 6 cases(35.3%), psychiatric behavior in 3 cases(17.6%), speech disturbance in 2 cases(11.8%), involuntary movement in 2 cases(11.8%), and depression in 1 case(5.9%) in order. 5)Cardiovascular complications showed tachycardia in 47 cases(28.3%), ischemic heart disease in 34 cases(18.6%), right bundle branch block in 6 cases(3.6%), left axis deviation in 4 cases(2.4%), atrial fibrillation in 3 cases(1.8%), sinus arrhythmia in 2 cases(1.2%), premature atrial contraction in 1 case(0.6%), premature ventricular contraction in 1 case(0.6%), primary atrio-ventricular block in 1 case(0.6%), prolonged QT in 1 case(0.6%). 6)Pulmonary complications were pneumonia in 23 cases(13.1%), pulmonary edema in 22 cases(12.6%), pneumonia with pulmonary edema in 3 cases(1.7%), and atelectasis, pulmonary hemorrhage, empyema, pleurisy in each 1 case(0.6%). 7)Azotemias were 26 cases(14.2%), clinically confirmed acute renal failures were 4 cases(2%) 8)Rhabdomyolysis was not rare as 63 cases(33.5%) compared to the previous report. 9)Dermatologic complications were erythema with bullae in 21 cases(11.9%), erythema without bullae in 14 cases(7.9%), bullae only in 10 cases(5.6%), laceration in 3 cases(1.65%), and ulceration in 1 case(0.55%). Conclusion ; We must consider other systemic manifestations as well as neurological symptoms in patients with CO intoxication since those are not infrequent in Korea.
Acute Kidney Injury ; Akinetic Mutism ; Arrhythmia, Sinus ; Atrial Fibrillation ; Atrial Premature Complexes ; Axis, Cervical Vertebra ; Bundle-Branch Block ; Carbon Monoxide Poisoning ; Carbon Monoxide* ; Carbon* ; Coal ; Coma ; Cooking ; Depression ; Dyskinesias ; Empyema ; Erythema ; Fires ; Heating ; Hemorrhage ; Hot Temperature ; Humans ; Korea ; Lacerations ; Medical Records ; Motor Vehicles ; Myocardial Ischemia ; Penicillin G Benzathine ; Peripheral Nervous System Diseases ; Pleurisy ; Pneumonia ; Pulmonary Atelectasis ; Pulmonary Edema ; Retrospective Studies ; Seizures ; Stroke ; Stupor ; Tachycardia ; Torticollis ; Ulcer ; Ventricular Premature Complexes

Carbon monoxide (CO) has the toxic effects of tissue hypoxia and produces various systemic and neurological complications. The main clinical manifestations of acute CO poisoning consist of symptoms caused by alterations of the cardiovascular system such as initial tachycardia and hypertension, and central nervous system symptoms such as headache, dizziness, paresis, convulsion and unconsciousness. CO poisoning also produces myocardial ischemia, atrial fibrillation, pneumonia, pulmonary edema, erythrocytosis, leucocytosis, hyperglycemia, muscle necrosis, acute renal failure, skin lesion, and changes in perception of the visual and auditory systems. Of considerable chinical interest, severe neurological manifestations may occur days or weekes after acute CO poisoning. Delayed sequelae of CO poisoning are not rare, usually occur in middle or older, and are clinically characterized by symptom triad of mental deterioration, urinary incontinence, and gait disturbance. Occasionally, movement disorders, particularly parkinsonism, are observed. In addition, peripheral neuropathy following CO poisoning usually occurs in young adults.
Animal ; Carbon Monoxide Poisoning/complications/*physiopathology ; Human

Datura stramonium is an annual herb, growing wild in the most part of our country. All parts of the plant contain belladonna alkaloid. Ingestion of Datura stramonium and the resulting toxic symptoms have been already reported throughout the world, but not in Korea. Two cases of acute anticholinergic symptom due to Datura stramonium intoxication are presented. The diagnosis in the first case was suspected on the basis of clinical signs and symptoms, comfirmed by the appearance of similar symptoms and signs in the second, history of ingestion of small amount of stramonium liquor and identification of the plant specimen obtained. Both recovered spontaneously without neurologic sequalae.
Atropa belladonna ; Datura stramonium* ; Datura* ; Diagnosis ; Eating ; Korea ; Plants

The meningitis occur within a closed anatomic space, so they have many similar clinical features and characteristic CSF abnormalities. But the temporal profile of many meningitis is distinctive from aseptic meningitis with spontaneous remission to bacterial or tuberculous meningitis with fatal outcome without treatment. Therefore early accurate differential diagnosis is required. The development of diagnostic tools and treatment, and increase of immunodeficient state and resistant pathogens have changed the distribution of main pathogens of meningitis from the past. Therefore we analyzed 241 medical records with final diagnosis as 'infectious meningitis' to evaluate the distribution of pathogens in Korea and any differential points of clinical, laboratory, and radiologic, profile according to etiology. 1. The etiologic distributions were followings, Aseptic meningitis in 100 patient(41.5%), tuberculous meningitis in 58 patients(24.1%), bacterial meningitis in 48 patients(19.9%), and fungal in 16 patients(6.6%). 2. The intense seasonal occurrence was noted in aseptic meningitis with summer. 3. Fever and headache were noted in almost all patients Altered mental status were noted in 39.6% of bacterial meningitis, 53.41% of tuberculous meningitis but not in fungal and aseptic meningitis. Meningeal irritation signs were noted in less patients(25%) with fungal meningitis but in more with aseptic, bacterial or tuberculous meningitis m 52-66.7%. Most of all focal neurologic signs were present in bacterial or tuberculous meningitis. 4. Many immunocompromized patients had fungal meningitis, three of which showed normal CSF leukocyte counts And it pointed up the importance of intensive etiologic evaluation in immunodeficient patients with clinically suspected symptoms of meningitis. 5. CSF findings at admission were following. CSF leukocytes were mean 206-258/yL in aseptic, tuberculous or fungal meningitis. But in bacterial meningitis leukocyte counts were greater than 1,000/mL in mom than half of patients. The differential counts of leukocytes were monocyte predominant except in bacterial meningitis. The reductions of CSF sugar were noted in bacterial, tuberculous, or fungal meningitis. Characteristically all patients with extremely low CSF sugar(less than 10mg/dL) had bacterial meningitis. 6. The most frequent pathologic findings in neuroimaging study were hydrocephalus(20patients: 9.1%) and meningeal enhancement(19patient,: 8.6%). Small enhancing mass(8patients: 3.6%.) and focal infarction(8patients: 3.6%) were noted less frequently. These abnormal radiologic findings were noted in 2 patients(2.0%) with aseptic meningitis, 15 patients(38.7%) with bacterial meningitis, 29 patients(50.0%) with tuberculous meningitis and 5 patients(35.7%) with fungal meningitis.
Adult* ; Diagnosis ; Diagnosis, Differential ; Fatal Outcome ; Fever ; Headache ; Humans ; Korea ; Leukocyte Count ; Leukocytes ; Medical Records ; Meningitis* ; Meningitis, Aseptic ; Meningitis, Bacterial ; Meningitis, Fungal ; Monocytes ; Neuroimaging ; Neurologic Manifestations ; Remission, Spontaneous ; Seasons ; Tuberculosis, Meningeal

Young adult stroke is not rare disease and have diverse causes. We studied 135 young adults aged 15 - 45 years who had been admitted to Severance Hospital with a diagnosis of cerebral infarction from January 1990 to June 1995. The results are as follows. 1. The diverse causes of earshot infarction in young adults have been found in most patients(88.2%). The major causes of cerebral infarction in young adults were atherosclerosis(32.6%) and cardioembolism(32.6%). The causes were significantly different between younger(15 - 30 years old) and older(31 - 45 years old) patients. 2. The major risk factors of atherosclerotic cerebral infarction were hypertension(29 patients), smoking(14 patients), and hyperlipidemia(11 patients). 3. The major causes of cardioembolism were valvular heart disease(21 patients) and prosthetic valve(I0 patients). The mitral valve prolapse was discovered only in one patient. 4. Fourteen patients had non-atherosclerotic vasculopathies. The moyamoya disease was the most common cause of them. 5. The other causes of cerebral infarction were found in 17 patients and the major causes were alcohol intoxication and postoperative thromboembolism. 6. The cerebral infarction occurred mostly in the carotid artery territory(95 patients) and the distribution of the involved vascular territory was not different between younger and older age groups. 7. The clinical outcomes were good in most patients (86, 7%). From the above results, we demonstrated that young adults with cerebral infarction had various causes and showed favorable clinical outcomes. We also found that the causes of cerebral infarction varied between younger and older groups. Our findings suggest that careful and thorough case-by-ease evaluation may be mandatory to clarify the causes of cerebral infarction in young adults.
Carotid Arteries ; Cerebral Infarction* ; Diagnosis ; Heart ; Humans ; Infarction ; Mitral Valve Prolapse ; Moyamoya Disease ; Rare Diseases ; Risk Factors ; Stroke ; Thromboembolism ; Young Adult*

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

Between 198O and 1985, 93 patients with Parkinson's disease (paralysls agitans) were seen and examined prior to the initiation of medication. Forty-four of them were men and 49 of them women. Their ages ranged from 32 to 86 years (mean, 56.7 years), with the peak incidence in the seventh decade. The initial symptoms were tremor (67.7%), gait disturbance (16.1%), stiffness (15.1%), back pain, and weakness. Durations of illness until final diagnosis ranged from 2 months to 8 years (mean, 1.5 years). The most frequent signs at first examination were rigidity (95.7%), masked face (94.4%), tremor (89.2%), bradykinesia (87.1%), festinating gait (81.2%) grabella sign, stooped posture, and low voice. No marked dementia was seen in this study, and mild mental change was present in only 7 patients (7.5%). According to the modified Hoehn and Yahr's classification, 13 patients were in stage I, 31 in stage II, 28 in stage III, 13 in stage IV, and 8 in stage V. The more advanced stages were associated with a longer duration of the disease. Fifteen (16.1%) had coexisting disease: 11, hypertension; 3, diabetes mellitus; 2, stroke; and 1, malignant neoplasm. All patients but one responded initially to levodopa (Sinemet).
Adult ; Aged ; Aged, 80 and over ; Electroencephalography ; Female ; Human ; Male ; Middle Age ; Parkinson Disease/diagnosis* ; Tomography, X-Ray Computed

The elongation and widening of intracranial vessels(fusiform aneurysm, ectasia) known to be related to various etiologies often causes neurologic focal signs because of the pressure on the adjacent structures and/or impaired circulation distal to ectatic vessel. We report two cases with pupil sparing ophthalmoplegia as a manifestation of carotid artery ectasia(the second case had signs of recurrent cerebrovascular attacks due to contralateral carotid artery occlusion).
Aneurysm* ; Carotid Arteries* ; Ophthalmoplegia* ; Pupil*

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