Journal of The Korean Society of Clinical Toxicology (대한임상독성학회지)

Korean society of Clincal Toxicology (대한임상독성학회)
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Motor Peripheral Neuropathy Involved Bilateral Lower Extremities Following Acute Carbon Monoxide Poisoning: A Case Report

급성 일산화탄소 중독 환자에서 발생한 양하지 말초 운동신경병증 1례

  • Choi, Jae-Hyung (Department of Emergency Medicine, College of Medicine, Soonchunhyang University) ;
  • Lim, Hoon (Department of Emergency Medicine, College of Medicine, Soonchunhyang University)
  • 최재형 (순천향대학교 의과대학 부천병원 응급의학과) ;
  • 임훈 (순천향대학교 의과대학 부천병원 응급의학과)
  • Received : 2015.05.21
  • Accepted : 2015.06.07
  • Published : 2015.06.30
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Abstract

Carbon monoxide (CO) intoxication is a leading cause of severe neuropsychological impairments. Peripheral nerve injury has rarely been reported. Following are brief statements describing the motor peripheral neuropathy involved bilateral lower extremities of a patient who recovered following acute carbon monoxide poisoning. After inhalation of smoke from a fire, a 60-year-old woman experienced bilateral leg weakness without edema or injury. Neurological examination showed diplegia and deep tendon areflexia in lower limbs. There was no sensory deficit in lower extremities, and no cognitive disturbances were detected. Creatine kinase was normal. Electroneuromyogram patterns were compatible with the diagnosis of bilateral axonal injury. Clinical course after normobaric oxygen and rehabilitation therapy was marked by complete recovery of neurological disorders. Peripheral neuropathy is an unusual complication of CO intoxication. Motor peripheral neuropathy involvement of bilateral lower extremities is exceptional. Various mechanisms have been implicated, including nerve compression secondary to rhabdomyolysis, nerve ischemia due to hypoxia, and direct nerve toxicity of carbon monoxide. Prognosis is commonly excellent without sequelae. Emergency physicians should understand the possible-neurologic presentations of CO intoxication and make a proper decision regarding treatment.

Keywords

References

  1. Prockop LD, Chichkova RI. Carbon monoxide intoxication: an updated review. J Neurol Sci 2007;262:122-30. https://doi.org/10.1016/j.jns.2007.06.037
  2. Choi IS, Kim SK, Choi YC, Lee SS, Lee MS. Evaluation of outcome after acute carbon monoxide poisoning by brain CT. Journal of Korean medical science 1993;8:78-83. https://doi.org/10.3346/jkms.1993.8.1.78
  3. Proceedings Satellite Meeting IUTOX VIIIth International Congress of Toxicology. "Carbon monoxide: the unnoticed poison of the 21st Century" 1998. Universite de Bourgogne, France.
  4. Weaver LK. Clinical practice. Carbon monoxide poisoning. N Engl J Med 2009;360:1217-25. https://doi.org/10.1056/NEJMcp0808891
  5. Choi IS. A clinical study of peripheral neuropathy in carbon monoxide intoxication. Yonsei Med J 1982;23:174-77. https://doi.org/10.3349/ymj.1982.23.2.174
  6. Choi IS. Peripheral neuropathy following acute carbon monoxide poisoning. Muscle Nerve 1986;9:265-66. https://doi.org/10.1002/mus.880090312
  7. Abelsohn A, Sanborn MD, Jessiman BJ, Weir E. Identifying and managing adverse environmental health effects: 6. Carbon monoxide poisoning. CMAJ 2002;166:1685-90.
  8. Garcia A, Maestro I. Reversible motor and sensory peripheral neuropathy in a patient following acute carbon monoxide intoxication. Electromyogr Clin Neurophysiol 2005;45:19-21.
  9. Gorman D, Drewry A, Huang YL, Sames C. The clinical toxicology of carbon monoxide. Toxicology 2003;187:25-38. https://doi.org/10.1016/S0300-483X(03)00005-2
  10. Handa PK, Tai DY. Carbon monoxide poisoning: a five year review at Tan Tock Seng Hospital, Singapore. Ann Acad Med Singapore 2005;34:611-14.
  11. Hampson NB, Piantadosi CA, Thom SR, Weaver LK. Practice recommendations in the diagnosis, management, and prevention of carbon monoxide poisoning. Am J Respir Crit Care Med 2012;186:1095-101. https://doi.org/10.1164/rccm.201207-1284CI
  12. Henry CR, Satran D, Lindgren B, Adkinson C, Nicholson CI, Henry TD. Myocardial injury and long-term mortality following moderate to severe carbon monoxide poisoning. JAMA 2006;295:398-402. https://doi.org/10.1001/jama.295.4.398
  13. Domachevsky L, Adir Y, Grupper M, Keynan Y, Bentur Y. Hyperbaric oxygen in the treatment of carbon monoxide poisoning. Clin Toxicol 2005;43:181-88. https://doi.org/10.1081/CLT-57864
  14. Choi IJ, Oh YH, Kim GT. Magnetic Resonance Imaging for the Prediction of Delayed Neuro-psychiatric Sequelae in Patients with Carbon Monoxide Poisoning. J Kor Soc Emerg Med 2013;2:164-73.
  15. Kinoshita T, Sugihara S, Matsusue E, Fujii S, Ametani M, Ogawa T. Pallidoreticular damage in acute carbon monoxide poisoning: diffusion-weighted MR imaging findings. AJNR Am J Neuroradiol 2005;26:1845-48.
  16. Alarie Y. Toxicity of fire smoke. Crit Rev Toxicol 2002;32:259-89. https://doi.org/10.1080/20024091064246