title: Bilateral brachial plexus injury following acute carbon monoxide poisoning.
abstract: BACKGROUND
  Carbon monoxide (CO) intoxication is a leading cause of severe neuropsychological impairments. Peripheral nerve injury has rarely been reported. It consists usually in a demyelinating polyneuropathy or mononeuropathy affecting mainly the lower limbs. Isolated involvement of both upper extremities has been described in only 4 patients related to root damage. We report the first case of bilateral brachial plexus injury following CO poisoning and review all previous CO-induced neuropathy described in literature.
  
  
  METHODS
  After being unconscious for three hours, a 42 years old man experienced bilateral brachial weakness associated with edema of the face and the upper limbs. Neurological examination showed a brachial diplegia, distal vibratory, thermic and algic hypoesthesia, deep tendon areflexia in upper limbs. There was no sensory or motor deficit in lower extremities. No cognitive disturbances were detected. Creatine kinase was elevated. Electroneuromyogram patterns were compatible with the diagnosis of bilateral C5 D1 brachial axonal plexus injury predominant on the left side. Clinical course after hyperbaric oxygen therapy was marked by a complete recovery of neurological disorders.
  
  
  CONCLUSIONS
  Peripheral neuropathy is an unusual complication of CO intoxication. Bilateral brachial plexus impairment is exceptional. Various mechanisms have been implicated including nerve compression secondary to rhabdomyolysis, nerve ischemia due to hypoxia and direct nerve toxicity of carbon monoxide. Prognosis is commonly excellent without any sequelae.
authors: Department of Neurology A and Neuropsychology, Hôpital des spécialités, Ibn Sina University Hospital, University Mohamed V Souissi, Avenue abderrahim bouabid, Rabat 10100, Morocco. mouniarahmani4@gmail.com.
authors: Mounia
authors: M
authors: Rahmani
authors: Halima
authors: H
authors: Belaidi
authors: Maria
authors: M
authors: Benabdeljlil
authors: Wafa
authors: W
authors: Bouchhab
authors: Nadia
authors: N
authors: El Jazouli
authors: Asmae
authors: A
authors: El Brini
authors: Saadia
authors: S
authors: Aidi
authors: Reda M
authors: RM
authors: Ouazzani
authors: Mustapha
authors: M
authors: El Alaoui Faris
mesh_terms: D000208:Acute Disease; D000328:Adult; D020516:Brachial Plexus Neuropathies / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D002249:Carbon Monoxide Poisoning / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D004576:Electromyography; D006801:Humans; D006931:Hyperbaric Oxygenation; D008297:Male; D016896:Treatment Outcome