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Delayed leukoencephalopathy after acute carbon monoxide intoxication.

Ana Filipa Geraldo1, Cristiana Silva2, Dulce Neutel3

  • 1Department of Neuroradiology, Hospital de Santa Maria (CHLN, EPE), Lisbon, Portugal ; Lisbon School of Medicine, Lisbon, Portugal.

Journal of Radiology Case Reports
|November 27, 2014
PubMed
Summary

Carbon monoxide (CO) intoxication can cause delayed leukoencephalopathy, a rare brain condition. This case highlights a patient who recovered from CO exposure but later developed neurological deficits, emphasizing the importance of recognizing this delayed complication.

Keywords:
Carbon monoxide poisoningdelayed post-ischemic encephalopathydiffusion magnetic resonance imagingheroin inhalation syndromemagnetic resonance spectroscopyneurotoxicity syndromes

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Area of Science:

  • Neurology
  • Toxicology
  • Neuroimaging

Background:

  • Delayed leukoencephalopathy is an uncommon neurological sequela following hypoxic-ischemic events.
  • Carbon monoxide (CO) intoxication is a recognized, though infrequent, cause of this delayed complication.
  • Early diagnosis and management are crucial for favorable outcomes.

Observation:

  • A 40-year-old male presented with acute neurocognitive and behavioral decline one month after accidental CO intoxication.
  • Initial CO exposure resulted in loss of consciousness and hospitalization, followed by apparent full recovery.
  • Delayed neuroimaging revealed confluent, symmetric white matter lesions consistent with demyelination.

Findings:

  • Magnetic resonance imaging (MRI) demonstrated restricted diffusion and spectroscopic abnormalities in the affected white matter.
  • The clinical presentation and imaging findings led to a diagnosis of CO-mediated delayed post-hypoxic leukoencephalopathy.
  • Other potential causes of leukoencephalopathy were systematically excluded.

Implications:

  • This case underscores the potential for delayed neurological sequelae after seemingly resolved CO poisoning.
  • Early recognition of delayed leukoencephalopathy is critical for timely intervention.
  • Hyperbaric oxygen therapy may be a beneficial treatment option, as suggested by the patient's favorable response.