Delayed Neuropsychiatric Syndrome Due to Unrecognized Carbon Monoxide Toxicity: A Case Report

Area of Science:

• Neurology
• Toxicology
• Pediatrics

Background:

• Carbon monoxide (CO) poisoning is a significant cause of pediatric mortality.
• Delayed neuropsychiatric syndrome (DNS) is a rare but serious complication of CO toxicity.
• Nonspecific neurological symptoms and variable imaging findings can complicate diagnosis.

Purpose of the Study:

• To highlight a rare case of pediatric CO toxicity presenting with DNS.
• To illustrate the diverse clinical and neuroimaging spectrum of CO toxicity and DNS.
• To emphasize the importance of considering CO toxicity in unexplained neurological presentations.

Main Methods:

• Case report of a 16-year-old male with unexplained neurological deficits.
• Clinical assessment including neurological examination and neuroimaging.
• Review of patient history to identify CO exposure source.

Main Results:

• Patient presented with acute neurological injury, initially improving but later developing agitation and dyskinetic movements.
• Neuroimaging revealed evolving brain injury, including bilateral globi pallidi involvement.
• Diagnosis of CO toxicity was confirmed, linked to a workplace water heater leak.

Conclusions:

• This case underscores the variability in clinical and imaging findings of CO toxicity.
• Maintaining CO toxicity on the differential diagnosis is critical for pediatric patients with unexplained neurological symptoms.
• Prompt identification and management of CO exposure are essential to prevent severe neurological sequelae.