Carbon monoxide poisoning

Dr Henry Knipe and Dr Yuranga Weerakkody et al.

Carbon monoxide (CO) poisoning can cause an anoxic-ischaemic encephalopathy. The neurotoxicity could lead to acute as well as delayed effects.

CO poisoning is related mostly to preventable causes such as 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:

  • CO strongly binds to haemoglobin and the resultant carboxy-haemoglobin in the blood stream can cause profound hypoxic/anoxic injury
  • CO also interferes with mitochondrial oxidative phosphorylation and activates polymorphonuclear leukocytes, which undergo diapedesis and cause brain lipid peroxidation; this results in the delayed effects of CO poisoning

Tends to bilaterally affect the brain. The globus pallidus is the most commonly affected area 2

Classically seen as low attenuation in the globus pallidus region. Other features include diffuse hypo-attenuation 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 restricted diffusion 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
Section: Pathology
Tag: cases
Synonyms or Alternate Spellings:
  • Carbon monoxide (CO) poisoning
  • Carbon monoxide neurotoxicity
  • CO neurotoxicity
  • CO poisoning

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