Carbon monoxide poisoning

Carbon monoxide (CO) poisoning may result in an anoxic-ischaemic encephalopathy, with acute as well as delayed effects.

Carbon monoxide poisoning is mostly preventable with common causes including malfunctioning heating systems, improperly ventilated motor vehicles, and residential fires 9. It is also observed as an attempt to commit suicide. 

Patients can present with 10:

  • acute symptoms of headache, dizziness, altered conscious state, seizures
  • chronic symptoms of cognitive decline, abnormal gait, faecal incontinence

The pathophysiology can be two fold:

  • carbon monoxide strongly binds to haemoglobin and the resultant carboxyhaemoglobin in the bloodstream can cause profound hypoxic/anoxic injury
  • carbon monoxide is also a respiratory chain metabolism toxin that interferes with mitochondrial oxidative phosphorylation and activates polymorphonuclear leukocytes, which undergo diapedesis and cause brain lipid peroxidation; this results in the delayed effects of carbon monoxide poisoning

Changes tend to be bilateral with the globus pallidus most commonly affected 2

Classically seen as low attenuation in the globus pallidus region. Other features include diffuse hypoattenuation in cerebral white matter 4.

Regions of involvement are similar to CT. Signal characteristics include:

  • T1: affected areas are usually low signal, haemorrhagic areas can be high signal
  • T2/FLAIR: affected areas are high signal
  • T1 C+ (Gd): can show patchy peripheral enhancement in affected areas in the acute phase 2
  • DWI: affected areas show increased diffusion signal in the acute phase

Treatment consists of administering 100% oxygen which accelerates the elimination of carboxyhaemoglobin 9.

For involvement in and around the globus pallidus, consider:

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Article information

rID: 11020
Synonyms or Alternate Spellings:
  • Carbon monoxide (CO) neurotoxicity
  • Carbon monoxide (CO) poisoning
  • CO neurotoxicity
  • CO poisoning

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