Neurological Sequelae After Acute Carbon Monoxide Poisoning

Area of Science:

• Neurology
• Toxicology
• Emergency Medicine

Background:

• Carbon monoxide poisoning (COP) is a significant cause of poisoning deaths.
• Delayed neurological sequel (DNS) is a potential neurological dysfunction following COP.
• A mass casualty incident involving COP from a faulty ventilation system presented a unique case study.

Observation:

• Five patients with severe COP, including loss of consciousness and shock, were treated.
• Initial management involved intubation, mechanical ventilation, and normobaric oxygen therapy (NBO2).
• While three patients recovered well, two developed DNS, characterized by diverse neuropsychological deficits.

Findings:

• NBO2 rapidly reversed elevated carboxyhemoglobin levels in all patients.
• DNS manifested with a range of cognitive, psychiatric, and motor symptoms.
• Magnetic resonance imaging (MRI) with gadolinium contrast is the preferred diagnostic tool for DNS.

Implications:

• The efficacy and optimal parameters for hyperbaric oxygen therapy (HBO2) in preventing DNS remain debated.
• Early and effective oxygenation is crucial for managing COP and potentially preventing DNS.
• DNS contributes to increased patient morbidity and healthcare costs, underscoring the need for improved treatment and prevention strategies.