title: Clinical studies on three cases of the interval form of carbon monoxide poisoning: serial proton magnetic resonance spectroscopy as a prognostic predictor.
abstract: Three patients with the interval form of carbon monoxide (CO) poisoning were studied for associations between their clinical courses and serial changes on: (1) MRI; (2) EEG; (3) single photon emission computed tomography with N-isopropyl-p-[123I]iodoamphetamine ([123I]IMP SPECT); and (4) proton magnetic resonance spectroscopy ([1HIMRS) to evaluate their usefulness as prognostic predictors. A hyperintense area on MRI T2-weighted images and a hypointense area on T1-weighted images, appearing in the deep white matter, persisted for a prolonged period even after improvement of the clinical symptoms, and did not become an accurate indicator of clinical evaluation or prognosis. [1H]MRS studies with the volume of interest set in the frontal lobe white matter revealed increases in choline-containing compounds, and reductions of N-acetylaspartate in all cases. These findings normalized in one subclinical case over time. Distinctive findings in the severe cases included increased lactate in two cases showing akinetic mutism, with a difference in prognosis noted according to the degree and period of persistence of this increase. EEG findings were relatively well correlated with clinical symptoms in the early period, with a good correlation no longer consistent after a certain period was exceeded. [123I]IMP SPECT findings did not always reflectclinical symptomatology either. These results indicate that [1H]MRS is the most useful indicator in the clinical evaluation of patients with the interval form of CO poisoning.
authors.affiliation: Department of Neuropsychiatry, Fukui Medical University, Japan. kazumasa@fmsrsa.fukui-med.ac.jp
authors.forename: K
authors.initials: K
authors.lastname: Sakamoto
authors.forename: T
authors.initials: T
authors.lastname: Murata
authors.forename: M
authors.initials: M
authors.lastname: Omori
authors.forename: H
authors.initials: H
authors.lastname: Kimura
authors.forename: M
authors.initials: M
authors.lastname: Nishio
authors.forename: I
authors.initials: I
authors.lastname: Murata
authors.forename: Y
authors.initials: Y
authors.lastname: Koshino
authors.forename: S
authors.initials: S
authors.lastname: Itoh
authors.forename: Y
authors.initials: Y
authors.lastname: Ishii
authors.forename: K
authors.initials: K
authors.lastname: Isaki
mesh_terms: D000328:Adult; D000405:Akinetic Mutism / Q000175:diagnosis; D001224:Aspartic Acid / Q000031:analogs & derivatives* / Q000378:metabolism; D001921:Brain / Q000378:metabolism* / Q000473:pathology; D001925:Brain Damage, Chronic / Q000175:diagnosis; D001931:Brain Mapping; D002249:Carbon Monoxide Poisoning / Q000175:diagnosis*; D002794:Choline / Q000378:metabolism*; D003952:Diagnostic Imaging; D004292:Dominance, Cerebral / Q000502:physiology; D005260:Female; D006801:Humans; D019344:Lactic Acid / Q000378:metabolism*; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D011379:Prognosis
chemical_list: D001224:Aspartic Acid; D019344:Lactic Acid; C000179:N-acetylaspartate; D002794:Choline