Clinical studies on three cases of the interval form of carbon monoxide poisoning: serial proton magnetic resonance spectroscopy as a prognostic predictor.

Abstract

Three patients with the interval form of carbon monoxide (CO) poisoning were studied for associations between their clinical courses and serial changes on: (1) MRI; (2) EEG; (3) single photon emission computed tomography with N-isopropyl-p-[123I]iodoamphetamine ([123I]IMP SPECT); and (4) proton magnetic resonance spectroscopy ([1HIMRS) to evaluate their usefulness as prognostic predictors. A hyperintense area on MRI T2-weighted images and a hypointense area on T1-weighted images, appearing in the deep white matter, persisted for a prolonged period even after improvement of the clinical symptoms, and did not become an accurate indicator of clinical evaluation or prognosis. [1H]MRS studies with the volume of interest set in the frontal lobe white matter revealed increases in choline-containing compounds, and reductions of N-acetylaspartate in all cases. These findings normalized in one subclinical case over time. Distinctive findings in the severe cases included increased lactate in two cases showing akinetic mutism, with a difference in prognosis noted according to the degree and period of persistence of this increase. EEG findings were relatively well correlated with clinical symptoms in the early period, with a good correlation no longer consistent after a certain period was exceeded. [123I]IMP SPECT findings did not always reflectclinical symptomatology either. These results indicate that [1H]MRS is the most useful indicator in the clinical evaluation of patients with the interval form of CO poisoning.

• Authors: K Sakamoto, T Murata, M Omori, H Kimura, M Nishio, I Murata, Y Koshino, S Itoh, Y Ishii, K Isaki
• Journal: Psychiatry research (Psychiatry Res) Vol. 83 Issue 3 Pg. 179-92 (Sep 28 1998) ISSN: 0165-1781 [Print] Ireland
• PMID: 9849727 (Publication Type: Case Reports, Journal Article)

Chemical References

• Aspartic Acid
• Lactic Acid
• N-acetylaspartate
• Choline

Topics

• Adult
• Akinetic Mutism (diagnosis)
• Aspartic Acid (analogs & derivatives, metabolism)
• Brain (metabolism, pathology)
• Brain Damage, Chronic (diagnosis)
• Brain Mapping
• Carbon Monoxide Poisoning (diagnosis)
• Choline (metabolism)
• Diagnostic Imaging
• Dominance, Cerebral (physiology)
• Female
• Humans
• Lactic Acid (metabolism)
• Magnetic Resonance Spectroscopy
• Male
• Middle Aged
• Prognosis