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Carbon monoxide poisoning

Dr Ian Bickle ◉ and Dr Yuranga Weerakkody ◉ et al.

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

On this page:

Article:

Epidemiology
Clinical presentation
Pathology
Radiographic features
Treatment and prognosis
Differential diagnosis
Related articles
References

Images:

Cases and figures

Epidemiology

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.

Clinical presentation

Patients can present with ¹⁰:

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

Pathology

The pathophysiology can be two fold:

carbon monoxide strongly binds to hemoglobin and the resultant carboxyhemoglobinin 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

Radiographic features

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

CT

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

MRI

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

T1: affected areas are usually low signal, hemorrhagic 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 and prognosis

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

Differential diagnosis

For involvement in and around the globus pallidus, consider:

mitochondrial encephalopathies: tends to affect other basal ganglia regions
- Leigh disease
- Kearns-Sayre syndrome
other toxic encephalopathies
- cyanide neurotoxicity: tends to also affect the cortex
- methanol neurotoxicity: tends to affect the putamen ⁷
- organophosphate neurotoxicity
other causes of anoxia
metabolic disorders
- Wilson disease
prion encephalopathies
- Creutzfeldt-Jakob disease

References

Toxic and metabolic encephalopathies

toxic
- overview by region
  - white matter
    - toxic leukoencephalopathy
  - grey matter
- by agent/substance
  - inhaled toxins
    - carbon monoxide poisoning
    - heroin ("chasing the dragon")
    - nitrous oxide poisoning
  - oral toxins
  - drugs (oral or IV)
- by systemic illness
  - hepatic encephalopathy
  - uremic encephalopathy
deficiency
- by substance
  - Wernicke encephalopathy (vitamin B₁)
metabolic
- Fabry disease (globotriaosylceramide)
- Fahr disease
- Wilson disease (copper)
mitochondrial
- Kearns-Sayre syndrome
- Leigh syndrome
- mitochondrial encephalopathy with lactic acidosis and stroke-like episodes (MELAS)
- myoclonus epilepsy with ragged red fibers (MERRF)
- mitochondrial deletion syndromes
  - POLG-related disorders
- progressive cerebral poliodystrophy (also known as Alpers syndrome)
- trichopoliodystrophy (also known as Menkes disease)

Article information

rID: 11020

System: Central Nervous System, Haematology, Forensic

Synonyms or Alternate Spellings:

Carbon monoxide (CO) neurotoxicity
Carbon monoxide (CO) poisoning
CO neurotoxicity
CO poisoning

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