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Delayed neuropsychiatric syndrome in a child following carbon monoxide poisoning

Akiko Kondo1, Yoshiaki Saito, Ayumi Seki

  • 1Divisions of Child Neurology, Institute of Neurological Sciences, Faculty of Medicine, Tottori University, Japan. holbergs@nifty.com

Brain & Development
|September 30, 2006
PubMed

Insights

Carbon monoxide (CO) poisoning can cause delayed neuropsychiatric syndrome in children, even after hyperbaric oxygen therapy. This case highlights atypical cortical laminar necrosis, suggesting complex CO poisoning pathomechanisms.

Area of Science:

  • Neurology
  • Toxicology
  • Pediatrics

Background:

  • Carbon monoxide (CO) poisoning is a significant public health concern, particularly in pediatric populations.
  • Hyperbaric oxygen (HBO) therapy is a standard treatment for CO poisoning, aiming to accelerate CO elimination and tissue oxygenation.
  • Delayed neuropsychiatric sequelae following CO poisoning, while known, are less commonly reported in children.

Observation:

  • A five-year-old boy presented with symptoms of CO poisoning and initially improved with HBO therapy.
  • He later developed delayed neurological deficits including lethargy, visual and gait disturbances, hemiparesis, and mood lability.
  • Electroencephalography showed slow frontal activity, and MRI revealed lesions in the hippocampus and cerebral cortex.

Findings:

  • The patient exhibited persistent neurological deficits despite a 10-day course of HBO therapy.
  • Follow-up MRI demonstrated lesions in the globus pallidum and characteristic cortical laminar necrosis.
  • These findings, particularly cortical laminar necrosis, are atypical for CO poisoning and suggest a broader pathomechanism.

Implications:

  • This case underscores the importance of vigilant, long-term neurological monitoring in children following CO exposure.
  • The atypical imaging findings challenge current understanding of CO poisoning's neuropathology.
  • Further research is warranted to elucidate the mechanisms underlying delayed neuropsychiatric syndrome and cortical lesions in pediatric CO poisoning.

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