• Journal of The Korean Society of Clinical Toxicology
• /
• v.13 no.1
• /
• pp.46-49
• /
• 2015

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.

• Journal of Sasang Constitutional Medicine
• /
• v.35 no.3
• /
• pp.1-11
• /
• 2023

Objective This case report is to show the effectiveness of Sasang Constitutional Medicine treatment on the patient with delayed encephalopathy after acute carbon monoxide intoxication. Methods A 40-year-old female patient diagnosed with delayed encephalopathy after carbon monoxide poisoning 2 weeks ago before visiting our hospital. The patient suffered gait disturbance and cognitive disorder. She was identified as Soyangin and treated with Sasang constitutional Herbal Medicine(Yangkyuksanwha-tang and Hyungbangjihwang-tang). Improvement of symptoms was evaluated through Korean Version of Mini Mental Status Examination score(MMSE-K), Modified Barthel Index(MBI), Manual Muscle Testing(MMT), Range of Motion(ROM) and Hand Function Test. Results After 7 weeks of treatment, total score of MMSE-K increased from 0 to 26, the patient could walk by herself and had no trouble carrying out her daily life. Conclusions This case showed the effectiveness of Sasang constitutional medicine treatment for delayed encephalopathy after acute carbon monoxide intoxication.

• The Journal of Korean Medicine
• /
• v.22 no.3
• /
• pp.169-178
• /
• 2001

After initial recovery from acute carbon monoxide (CO) intoxication, some patients occasionally undergo severe neuropsychiatric deterioration, which is called postanoxic delayed encephalopathy (sequelae). This is the clinical report about one patient, a 73-year-old man, diagnosed with delayed encephalopathy after acute CO intoxication. The symptoms of the patient were mental dysfunction including memory impairment and disorientation, abnormal behavior, incontinence and mutism. He had completely recovered after an aonxic episode, but the neurological symptoms that developed were preceded by an interval of apparent normality (the 'lucid interval'). We characterized him as suffering deficiency syndrome of the heart and prescribed for him Bokreongbosim-tang and Guipi-tang, and thereafter his symptoms were remarkably improved. For the evaluation of clinical improvement, we use the Modified Barthel Index (MBI), Canadian Neurologic Scale (CNS), and the Korean version of the Mini-Mental State Examination (K-MMSE)

• Journal of The Korean Society of Clinical Toxicology
• /
• v.17 no.2
• /
• pp.66-78
• /
• 2019

Purpose: Thallium (TI+) autometallography is often used for the imaging of neuronal metabolic activity in the rodent brain under various pathophysiologic conditions. The purpose of this study was to apply a thallium autometallographic technique to observe changes in neuronal activity in the forebrain of rats following acute carbon monoxide (CO) intoxication. Methods: In order to induce acute CO intoxication, adult Sprague-Dawley rats were exposed to 1100 ppm of CO for 40 minutes, followed by 3000 ppm of CO for 20 minutes. Animals were sacrificed at 30 minutes and 5 days after induction of acute CO intoxication for thallium autometallography. Immunohistochemical staining and toluidine blue staining were performed to observe cellular damage in the forebrain following intoxication. Results: Acute CO intoxication resulted in significant reduction of TI+ uptake in major forebrain structures, including the cortex, hippocampus, thalamus, and striatum. In the cortex and hippocampal CA1 area, marked reduction of TI+ uptake was observed in the cell bodies and dendrites of pyramidal neurons at 30 minutes following acute CO intoxication. There was also strong uptake of TI+ in astrocytes in the hippocampal CA3 area following acute CO intoxication. However, there were no significant histological findings of cell death and no reduction of NeuN (+) neuronal populations in the cortex and hippocampus at 5 days after acute CO intoxication. Conclusion: The results of this study suggest that thallium autometallography can be a new and useful technique for imaging functional changes in neural activity of the forebrain structure following mild to moderate CO intoxication.

• Investigative Magnetic Resonance Imaging
• /
• v.20 no.3
• /
• pp.175-180
• /
• 2016

Carbon monoxide (CO) intoxication is a leading cause of the variable neuropsychiatric impairment. Despite of widely known central nerve system complications after CO intoxication, peripheral neuropathy due to CO poisoning is rare and has been under-recognized. We report interesting case of a 29-year-old male who suffered from motor weakness and sensory abnormalities in his lower extremity following acute CO intoxication. The patient revealed direct and indirect signs of peripheral neuropathy of the left inferior gluteal and sciatic nerve on magnetic resonance imaging.

• Journal of Physiology & Pathology in Korean Medicine
• /
• v.19 no.1
• /
• pp.279-283
• /
• 2005

After initial recovery from acute carbon monoxide(CO) intoxication, some patients occasionally undergo severe neuropsychiatric deterioration, which is called postanomic delayed encephalopathy(sequelae). This is the clinical study about one patient, a 53-year-old woman, diagnosed with delayed encephalopathy after acute CO intoxication. The patient's symptoms were mental dysfunction including memory impairment and disorientation, aphasia, atrophy and weakness throughtout the body. She had completely recovered after an anomic episode, but the neurological symptoms that developed were preceded by an interval of apparent nomality.(the 'lucid interval'). She was characterized as suffering deficiency syndrome of the heart(心虛) and was prescribed for her an Ansinschungnoi-tang(安神淸腦湯), and thereafter her symptoms improved remarkably. For the evaluation of clinical improvement, we use the Modified Barthel Index(MBI).

• Journal of the Korean neurological association
• /
• v.36 no.4
• /
• pp.358-362
• /
• 2018

Delayed anoxic encephalopathy after carbon monoxide (CO) poisoning is characterized by neurological deterioration that occurs after recovery from acute CO intoxication. There has been no established therapy. We report a patient recovered from acute CO intoxication developed various neurological symptoms. After the administration of high dose prednisolone and anticholinesterase inhibitor, the therapeutic effect was remarkable and confirmed by quantitative analysis of diffusion-tensor imaging (DTI). DTI could be used to evaluate the therapeutic effect for delayed anoxic encephalopathy after CO poisoning.

• The Journal of Internal Korean Medicine
• /
• v.40 no.5
• /
• pp.957-966
• /
• 2019

Carbon monoxide intoxication leads to hypoxia, which eventually leads to tissue ischemia. Delayed neuropsychiatric syndrome (DNS) can be a consequence and appears in the form of cognitive impairment and movement disorders after a lucid interval. A 58-year-old Korean male was admitted to our hospital with delayed neuropsychiatric sequelae (DNS) after an 11-day lucid interval following recovery from acute carbon monoxide intoxication. We treated him with herbal medication, acupuncture, electroacupuncture, and moxibustion. The effects were assessed by the activity index and Mini Mental State Examination-Korea (MMSE-K) scores, and by changes in gait disturbance. In this case, the clinical symptoms, including gait disturbance, and the activity index and MMSE-K scores, improved after traditional Korean treatment. The findings of this case report suggest that traditional Korean medicine treatment can be effective for treatment of symptoms of delayed neuropsychiatric sequelae due to CO intoxication.

• Journal of The Korean Society of Clinical Toxicology
• /
• v.9 no.2
• /
• pp.88-94
• /
• 2011

Purpose: Delayed neuropsychological sequelae (DNS) commonly occurs after recovery from acute carbon monoxide poisoning. The aim of this article is to identify the factors associated with DNS development. Methods: We retrospectively evaluated patients, admitted to the medical center emergency department from June 2005 to March 2011, who were suffering from acute carbon monoxide (CO) poisoning. We categorized the patients into two groups - those with DNS, and those without DNS. Multiple regression analysis was performed to identify the factors related to manifestation of DNS. Results: Of the total one hundred fifty seven patients (157) recruited for the study, twenty two (22) developed DNS. Longer CO exposure times and lower GCS scores were positively associated with development of DNS symptoms. Conclusion: Our study identified two potential factors which are predictive of DNS development in CO intoxication, however, more studies are needed. Adequate follow-up after hospital discharge to monitor for and accurately identify manifestation of DNS, is also important.

• Journal of Yeungnam Medical Science
• /
• v.8 no.1
• /
• pp.86-97
• /
• 1991

To obtain the basic data of prognosis of acute carbon monoxide(CO) intoxication, one hundred and sixteen cases of CO intoxication defined by carboxyhemoglobin(COHb) and admitted via emergency room of Yeungnam University Hospital from Oct. '85 to April' 89 have been clinically analyzed and evaluated, including delayed postanoxic encephalopathy(DPE) and the following results were obtained. 1. The ratio of male to female was 1:1.5 and mental state was drowsy mostly(26.2% of 116 cases) 2. The more disturbed the mental state, the more decreased was the arterial pH and $PaCO_2$, which may be the result of metabolic acidosis. 3. The early laboratory findings in patients of CO intoxication were as follows : leukocytosis-65.5%, increase of hematocrit-23.3%, hyperglycemia-19.8%, increase of GPT-19.8% increase of creatinine-0.9%, and glucosuria-12.1%. 4. The early findings of EKG were abnormal in 35.3% : change of rhythm-25.0%, abnormal ST segment-15.5% (change of rhythm and abonormal ST segment-5.2%) but the conduction disorder was not present. 5. The abnormal EEG above mild degree was 93.1%, of which moderate was most frequent(80.2%). 6. The incidence of DPE was 7.8% among all admitted CO patients. DPE cases had long duration of exposure time(8 hours), severe leukocytosis(20,000) and an abnormal EEG(MA).