title: Pallidoreticular lesion in carbon monoxide intoxication by gradient echo: report of a case with parkinsonism features and review of the literature.
abstract: OBJECTIVE
  Pallidoreticular damage was defined by lesions involving both the pallidum and the substantia nigra and was only reported in four cases after CO intoxication.
  
  
  METHODS
  We report a patient with initial consciousness disturbances followed by parkinsonian features after carbon monoxide intoxication. The unique features in this patient included primary globus pallidus hemorrhage followed by delayed hemorrhage in pallidoreticular topography demonstrated by T1- and T2-weighted imaging. In the follow-up study 7 months later, the patient still presented with parkinsonism features and executive dysfunction while the pallidoreticular signal was only visible by gradient echo sequences but not the other MR conventional sequences. Hypometabolism in the frontal and basal ganglion regions were evident from 99mTc-TRODAT-1 study and partial responsiveness to levodopa in alleviating parkinsonian features was considered.
  
  
  CONCLUSIONS
  This case highlights the delayed development of pallidoreticular damages and its linkage in modulating prefrontal-subcortical neuronal circuits.
authors.affiliation: Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Nai-Ching
authors.initials: NC
authors.lastname: Chen
authors.forename: Chun-Chung
authors.initials: CC
authors.lastname: Lui
authors.forename: Shu-Hua
authors.initials: SH
authors.lastname: Huang
authors.forename: Chi-Wei
authors.initials: CW
authors.lastname: Huang
authors.forename: Chen-Chang
authors.initials: CC
authors.lastname: Lee
authors.forename: Wen-Neng
authors.initials: WN
authors.lastname: Chang
authors.forename: Chang-Hung
authors.initials: CH
authors.lastname: Chen
authors.forename: Yu-Ting
authors.initials: YT
authors.lastname: Lin
authors.forename: Chiung-Chih
authors.initials: CC
authors.lastname: Chang
mesh_terms: D000978:Antiparkinson Agents / Q000627:therapeutic use; D002249:Carbon Monoxide Poisoning / Q000150:complications / Q000473:pathology*; D002540:Cerebral Cortex / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D005917:Globus Pallidus / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D015609:Organotechnetium Compounds; D020734:Parkinsonian Disorders / Q000188:drug therapy / Q000209:etiology; D019275:Radiopharmaceuticals; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D014326:Tropanes
chemical_list: D000978:Antiparkinson Agents; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D014326:Tropanes; C104196:technetium Tc 99m TRODAT-1; D007980:Levodopa