OBJECTIVETo compare the efficacy differences on delayed encephalopathy after carbon monoxide poisoning (DEACMP) between acupuncture to restore consciousness combined with hyperbaric oxygen treatment and simple hyperbaric oxygen treatment.

METHODSForty-one patients with DEACMP were randomly divided into an observation group (21 cases) and a control group (20 cases). In the observation group, acupuncture was applied at Neiguan (PC 6), Shuigou (GV 26), Baihui (GV 20), Sishencong (EX-HN 1), Fengchi (GB 20), Hegu (LI 4), Sanyinjiao (SP 6) and Taichong (LR 3), and hyperbaric oxygen treatment was given as well. In the control group, simple hyperbaric oxygen treatment was used. The treatment was adopted once every day, and continuous 5 days' treatment made one session in the two groups. There were two days at the interval between two sessions and 6 sessions in the two groups. The changes of scores of mini mental state examination (MMSE) and Barthel index (BI) for activity of daily life and routine electroencephalogram (EEG) before and after treatment were compared.

RESULTSAfter treatment, the scores of MMSE and BI and EEG were all improved compared with those before treatment (all P<0.01). The raise of the scores of MMSE and BI in the observation group was more obvious than that in the control group (both P<0.05) and the improvement of EEG abnormal condition in the observation group was also superior to that in the control group after treatment (P<0.05).

CONCLUSIONAcupuncture to restore consciousness combined with hyperbaric oxygen could obviously improve the cognitive function, activity of daily life and changes of EEG, and it is better than simple hyperbaric oxygen treatment.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Aged ; Aged, 80 and over ; Brain Diseases ; etiology ; psychology ; therapy ; Carbon Monoxide Poisoning ; complications ; Combined Modality Therapy ; Consciousness ; Female ; Humans ; Hyperbaric Oxygenation ; Male ; Middle Aged ; Treatment Outcome ; Young Adult

OBJECTIVETo explore the diagnostic value of magnetic resonance (MR) diffusion tensor imaging (DTI) in detecting brain white matter (WM) damage of patients with delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) and evaluating their cognitive dysfunction.

METHODSThirteen patients with DEACMP and thirteen age- and sex-matched volunteers underwent DTI using 1.5T MR scanner. FA and ADC values of 16 WM regions of interests (ROIs) were measured on DTI by two experienced radiologists independently with double blind methods, cognitive functions were evaluated by another experienced neurologist blinded to patient's medical history using the Montreal cognitive assessment (MoCA). ADC and FA values in DEACMP patients, and their correlations with cognitive dysfunction were analyzed.

RESULTSADC values of DEACMP patients increased significantly in all ROIs (P < 0.05) in comparison with the corresponding ROIs of healthy controls, whereas FA values were significantly decreased in all ROIs (P < 0.05) in comparison with that in controls except the bilateral optic radiations, anterior and posterior internal capsules. MoCA scores were positively correlated with FA values of bilateral lower frontal (r(L) = 0.736, P = 0.011; r(R) = 0.762, P = 0.003) lobe, temporal lobe (r(L) = 0.605, P = 0.016; r(R) = 0.559, P = 0.021) and total average WM (r(A) = 0.688, P = 0.001), however it inversely correlated with ADC values of bilateral lower frontal WM (r(L) = -0.674, P = 0.007; r(R) = -0.681, P = 0.019).

CONCLUSIONDTI can quantitatively reveal WM microstructure damage of DEACMP patients, indicate the severity of cognitive dysfunctions, and provide important information for pathogenesis and pathological study for DEACMP.

Brain ; pathology ; Brain Diseases ; diagnosis ; etiology ; Carbon Monoxide Poisoning ; complications ; Cognition ; Cognition Disorders ; Diffusion Magnetic Resonance Imaging ; Diffusion Tensor Imaging ; Double-Blind Method ; Humans ; White Matter ; pathology

Brain Diseases ; etiology ; Carbon Monoxide Poisoning ; complications ; Humans ; Pulmonary Embolism ; complications

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

OBJECTIVETo investigate the changes in serum level of high mobility group protein B1 (HMGB1) in patients with delayed encephalopathy after acute carbon monoxide poisoning and the clinical significance of these changes.

METHODSThirty-four patients with delayed encephalopathy after acute carbon monoxide poisoning (delayed encephalopathy group), 30 normal controls (control group), and 32 cases of acute carbon monoxide poisoning without delayed encephalopathy (carbon monoxide poisoning group) were recruited in this study. The serum HMGB1 level was determined by enzyme-linked immunosorbent assay. The correlation between serum HMGB1 level and scores of the activity of daily living scale (ADL), Information-Memory-Concentration Test (IMCT), and Hasegawa dementia scale (HDS) was determined.

RESULTSIn the acute stage of carbon monoxide poisoning, the serum HMGB1 level of delayed encephalopathy group was significantly higher than those of the carbon monoxide poisoning group and the control group (P < 0.01). In the delayed encephalopathy group, serum HMGB1 level in the convalescent stage was significantly lower than that in the acute stage (P < 0.05); ADL score was higher and HDS and IMCT scores were lower in the acute stage than in the convalescent stage (P < 0.01). In the delayed encephalopathy group, serum HMGB1 level was positively correlated with HDS and ADL scores in both acute stage and convalescent stage (correlation coefficients: 0.612, 0.607, 0.609, and 0.612, P < 0.01).

CONCLUSIONHMGB1, as an important late mediator of inflammation, is involved in the inflammatory reaction in delayed encephalopathy, and is positively correlated with HDS and ADL scores, indicating that it can be used as one of the major indicators in monitoring carbon monoxide poisoning.

Adult ; Aged ; Aged, 80 and over ; Brain Diseases ; blood ; etiology ; Carbon Monoxide Poisoning ; blood ; complications ; Female ; HMGB1 Protein ; blood ; Humans ; Male ; Middle Aged

OBJECTIVETo study the MRI-based characteristics of acute carbon monoxide poisoning (ACOP) and delayed encephalopathy after acute carbon monoxide poisoning (DECAMP), and to compare the degree of brain damage.

METHODSA retrospective analysis was performed on the clinical and MRI data of 27 patients diagnosed with ACOP and 35 patients diagnosed with DECAMP. Ten healthy volunteers were recruited in the normal control group. All subjects received both routine MRI and diffusion-weighted MRI. Apparent diffusion coefficient (ADC) was determined with symmetric measurement of region of interest in the bilateral globus pallidus, white matter around lateral ventricle, and centrum semiovale. ADC values were compared afterwards.

RESULTSThirteen of the 27 ACOP cases were found of symmetrical abnormal signal in the bilateral globus pallidus, among whom 8 patients only showed pallidum region involvement, while the other 5 patients showed involvement of other regions. Eight ACOP patients showed cortical and subcortical white matter involvement, and 4 cases showed diffused abnormal signal around the bilateral ventricles and in the bilateral centrum semiovale. Two cases of ACOP presented with multiple region involvement. Thirty-five DECAMP patients showed diffused swelling and symmetric demyelination in multiple regions of the brain parenchyma. The periventricular white matter and centrum semiovale were involved in 33 cases, the deep brain nuclei were involved in 23 cases, and the cerebral cortex was involved in 3 cases. The ACOP and DECAMP groups had significantly lower ADC values in the periventricular white matter and bilateral centrum semiovale than the normal control group (P < 0.05), and the ADC values were significantly lower in the DECAMP group than in the ACOP group (P < 0.05). The ACOP group had a significantly lower ADC value in the globus pallidus than the DECAMP group and normal control group (P < 0.05); the DECAMP group had a significantly higher ADC value in the globus pallidus than the ACOP group and normal control group (P < 0.05).

CONCLUSIONRoutine MRI and ADC value can evaluate the degree of brain damage in ACOP and DECAMP patients based on lesion involvement on a more microscopic scale. It can provide valuable information for therapy selection and prognostic evaluation.

Adult ; Aged ; Brain Diseases ; chemically induced ; diagnosis ; Carbon Monoxide Poisoning ; complications ; diagnosis ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

OBJECTIVEBy explore the role of serum soluble Fas (sFas) in occurrence and progression of delayed encephalopathy after acute carbon monoxide poisoning (DEACMP).

METHODSEnzyme-linked immunosorbent assay (ELISA) was used to detect serum sFas levels in 40 patients with DEACMP in acute stage and convalescent stage, with 36 healthy elderly subjects as the control group.

RESULTSSerum sFas levels of the patients with DEACMP in both the acute and convalescent stages showed no significant difference from those in the control group (P=0.737 and 0.137, respectively), nor was any significant difference found between the patients in acute and exacerbation stages (P=0.059).

CONCLUSIONSerum sFas is not involved in the occurrence and progression of DEACMP.

Adult ; Aged ; Aged, 80 and over ; Brain Diseases ; etiology ; Carbon Monoxide Poisoning ; blood ; complications ; Case-Control Studies ; Female ; Humans ; Male ; Middle Aged ; fas Receptor ; blood

Adult ; Carbon Monoxide Poisoning ; complications ; psychology ; Humans ; Male ; Middle Aged ; Nervous System Diseases ; chemically induced ; diagnosis ; physiopathology ; Suicide, Attempted ; psychology

OBJECTIVETo explore the changes and the clinical significance of 5-hydroxytryptamine (5-HT), dopamine (DA) levels in serum and cerebrospinal fluid (CSF) of patients with delayed encephalopathy (DEACMP) after acute carbon monoxide poisoning.

METHODSThe dynamic detection of 5-HT and DA levels in serum and CSF from 42 patients with DEACMP was performed with high performance liquid chromatography (HPLC). The condition changes of patients with DEACMP were analyzed with three types of scales: the activity of daily living scale (ADL), information memory concentration test (IMCT) and Hasegawa's dementia scale (HDS); these changes were compared with those from 38 other encephalopathy patients and 38 non-encephalopathy patients, respectively.

RESULTSBefore treatment, the serum 5-HT and DA levels [(662.61 ± 178.50) and (155.74 ± 60.32) nmol/L, respectively] of DEACMP group were both significantly lower than those [(914.08 ± 198.04) and (225.70 ± 48.53) nmol/L] of non-encephalopathy group (P < 0.05); the serum DA level of DEACMP group was also significantly lower than that [(243.57 ± 66.94) nmol/L] of other encephalopathy group (P < 0.05); the serum 5-HT level of DEACMP group was not significantly different from that [(729.54 ± 299.87) nmol/L] of other encephalopathy group (P > 0.05). After treatment, the serum 5-HT and DA levels [(714.08 ± 170.47) and (192.18 ± 33.07 nmol/L, respectively)] of DEACMP group elevated to various extent, but only serum DA level was significantly higher than that before treatment (P < 0.05). Before treatment, the CSF 5-HT and DA levels of DEACMP group were significantly lower than those of non-encephalopathy group and those of other encephalopathy group (P < 0.05). After treatment, the CSF 5-HT level (232.44 ± 54.28 nmol/L) was similar to normal level and significantly higher than that before treatment (P < 0.05); the CSF DA level [(56.83 ± 12.85) nmol/L] of DEACMP group increased only slightly (P > 0.05). In DEACMP group, ADL score (50.64 ± 7.23), HDS score (8.55 ± 8.08) and IMCT score (4.95 ± 7.30) before treatment were significantly different from those (8.5 ± 8.08, 4.95 ± 7.30 and 15.64 ± 10.90) after treatment (P < 0.01). In DEACMP group, there wasa negative correlation between DA level changes and HDS score changes, when the DA levels and HDS scores before treatment were compared with those after treatment (P < 0.05).

CONCLUSIONThe dynamic changes of 5-HT and DA levels in serum and CSF of patients with DEACMP consisted basically with the patient's condition change. The dynamically detected 5-HT and DA levels can be used as the biological indicators to reflect the condition change and treatment effects of DEACMP patients.

Adult ; Aged ; Aged, 80 and over ; Brain Diseases ; blood ; cerebrospinal fluid ; etiology ; Carbon Monoxide Poisoning ; blood ; cerebrospinal fluid ; complications ; Case-Control Studies ; Dopamine ; blood ; cerebrospinal fluid ; Female ; Humans ; Male ; Middle Aged ; Neurotoxicity Syndromes ; blood ; cerebrospinal fluid ; etiology ; Serotonin ; blood ; cerebrospinal fluid

OBJECTIVETo compare therapeutic effects of acupuncture combined with hyperbaric oxygenation and simple hyperbaric oxygenation on delayed encephalopathy in the patient of acute carbon monoxide poisoning.

METHODSSixty inpatients were randomly divided into an observation group and a control group. The observation group were treated with acupuncture at Neiguan (PC 6), Shuigou (GV 26), Sanyinjiao (SP 6), Baihui (GV 20), Sishencong (EX-HN 1), etc., and hyperbaric oxygenation. The control group were treated with simple hyperbaric oxygenation. Nerve function defect was evaluated.

RESULTSThe total effective rate was 96.7% in the observation group and 86.7% in the control group, the observation group being significantly higher than the control group (P < 0.05).

CONCLUSIONAcupuncture combined with hyperbaric oxygenation has a significant therapeutic effect on delayed encephalopathy in the patient of acute carbon monoxide poisoning.

Acupuncture Therapy ; Acute Disease ; Adult ; Brain Diseases ; therapy ; Carbon Monoxide Poisoning ; complications ; Combined Modality Therapy ; Female ; Humans ; Hyperbaric Oxygenation ; Male ; Middle Aged