title: Neurologic and radiologic manifestations of three girls surviving acute carbon monoxide poisoning.
abstract: We report the neurologic and radiologic manifestations of three adolescent girls with acute carbon monoxide poisoning. The girls were found collapsed and unconscious in a bathroom where liquid petroleum gas was being used as heating fuel. As hyperbaric oxygen therapy was not available locally, they only received oxygen supplementation via nasal cannula (4 L/minute) as treatment in the first 2 days. On transfer to a tertiary center in Hong Kong, evolving neurologic manifestations of visual acuity and field deficits, confusion, and focal motor weaknesses were observed. Focal infarctions were evident in cerebral computed tomography in one patient and cortical lesions on magnetic resonance imaging in all three patients. [18F]Fluorodeoxyglucose (FDG) positron emission tomography (PET) revealed additional decreased metabolism in the basal ganglia in two patients, which was typical of carbon monoxide poisoning. The neurologic deficits resolved completely at 3 weeks after the exposure, but psychologic symptoms succeeded. This report serves to alert clinicians to the varied neuro-ophthalmologic manifestations and psychologic impairment even with the same duration of carbon monoxide poisoning. PET might be more sensitive in detecting cerebral injuries specific for carbon monoxide poisoning.
authors.affiliation: Department of Pediatrics, Chinese University of Hong Kong, 6/F Clinical Sciences Building, Prince of Wales Hospital, Shatin, Hong Kong. ehon@cuhk.edu.hk
authors.forename: Kam-lun Ellis
authors.initials: KL
authors.lastname: Hon
authors.forename: Wai-lan
authors.initials: WL
authors.lastname: Yeung
authors.forename: Chi-hang Assunta
authors.initials: CH
authors.lastname: Ho
authors.forename: Wing-kwan Alex
authors.initials: WK
authors.lastname: Leung
authors.forename: Albert Martin
authors.initials: AM
authors.lastname: Li
authors.forename: Winnie Chiu-wing
authors.initials: WC
authors.lastname: Chu
authors.forename: Yu-leung
authors.initials: YL
authors.lastname: Chan
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D001479:Basal Ganglia / Q000378:metabolism* / Q000473:pathology; D002249:Carbon Monoxide Poisoning / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D002540:Cerebral Cortex / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000209:etiology*; D002648:Child; D003221:Confusion / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D010102:Oxygen Inhalation Therapy; D049268:Positron-Emission Tomography; D017741:Survivors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014786:Vision Disorders / Q000209:etiology* / Q000503:physiopathology