title: The impacts of acute carbon monoxide poisoning on the brain: Longitudinal clinical and 99mTc ethyl cysteinate brain SPECT characterization of patients with persistent and delayed neurological sequelae.
abstract: OBJECTIVE
  Acute carbon monoxide (CO) poisoning poses a significant threat to the central nervous system. It can cause brain injury and diverse neurological deficits including persistent neurological sequelae (PNS) and delayed neurological sequelae (DNS). The study aimed to investigate the long-term impacts of acute CO poisoning on brain perfusion and neurological function, and to explore potential differences between PNS and DNS patients.
  
  
  METHODS
  We evaluated brain perfusion using (99m)Tc ethyl cysteinate (ECD) brain single photon emission computed tomography (SPECT) and assessed clinical neurological symptoms and signs one month following acute poisoning. For DNS patients, ECD SPECT and clinical evaluation were performed when their delayed symptoms appeared. All patients had follow-up SPECT imaging, along with clinical assessments six months following poisoning.
  
  
  RESULTS
  12 PNS and 12 DNS patients were recruited between 2007 and 2010. Clinically, the main characteristic presentations were cognitive decline, emotional instability, and gait disturbance. SPECT imaging demonstrated consistent frontal hypoperfusion of varying severities in all patients, which decreased in severity at follow-up imaging. DNS patients usually had more severe symptoms and perfusion defects, along with worse clinical outcomes than the PNS group.
  
  
  CONCLUSIONS
  These results suggest that acute CO poisoning might lead to long term brain injuries and neurological sequelae, particularly in DNS patients.
authors.affiliation: Department of Neurology, Cardinal Tien Hospital, Taipei, Taiwan; School of Medicine, Fu-Jen Catholic University, Taipei, Taiwan. Electronic address: chungfentsai@yahoo.com.tw.
authors.forename: Chung-Fen
authors.initials: CF
authors.lastname: Tsai
authors.affiliation: Department of Neurology, Cardinal Tien Hospital, Taipei, Taiwan; School of Medicine, Fu-Jen Catholic University, Taipei, Taiwan.
authors.forename: Ping-Keung
authors.initials: PK
authors.lastname: Yip
authors.affiliation: Department of Hyperbaric Medicine, Cardinal Tien Hospital, Taipei, Taiwan; School of Medicine, Fu-Jen Catholic University, Taipei, Taiwan.
authors.forename: Shao-Yuan
authors.initials: SY
authors.lastname: Chen
authors.affiliation: Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Jen-Cheng
authors.initials: JC
authors.lastname: Lin
authors.affiliation: Department of Clinical Psychology, Fu-Jen Catholic University, Taipei, Taiwan.
authors.forename: Zai-Ting
authors.initials: ZT
authors.lastname: Yeh
authors.affiliation: Department of Hyperbaric Medicine, Cardinal Tien Hospital, Taipei, Taiwan.
authors.forename: Lan-Yu
authors.initials: LY
authors.lastname: Kung
authors.affiliation: Department of Chest Medicine, Cardinal Tien Hospital, Taipei, Taiwan; School of Medicine, Fu-Jen Catholic University, Taipei, Taiwan.
authors.forename: Cheng-Yi
authors.initials: CY
authors.lastname: Wang
authors.affiliation: Department of Nuclear Medicine, Cardinal Tien Hospital, Taipei, Taiwan; School of Medicine, Fu-Jen Catholic University, Taipei, Taiwan. Electronic address: ymfan88@gmail.com.
authors.forename: Yu-Ming
authors.initials: YM
authors.lastname: Fan
mesh_terms: D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging* / Q000503:physiopathology; D002249:Carbon Monoxide Poisoning / Q000000981:diagnostic imaging* / Q000503:physiopathology; D015331:Cohort Studies; D003553:Cystine / Q000031:analogs & derivatives; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D011446:Prospective Studies; D013667:Technetium; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D015609:Organotechnetium Compounds; C541351:ethyl cysteinate dimer; D003553:Cystine; D013667:Technetium
keywords: Carbon monoxide; Neurological sequelae; Outcome; Poisoning; SPECT