title: Delayed leukoencephalopathy after acute carbon monoxide intoxication.
abstract: Delayed leukoencephalopathy is an uncommon complication of hypoxic-ischemic events of different etiologies, including carbon monoxide intoxication. We present a case of a 40-year-old male patient who was admitted with rapidly progressive neurocognitive and behavioral deficits. There was a history of accidental carbon monoxide intoxication one month before, presenting with loss of consciousness and short hospitalization, followed by a complete clinical recovery. The imaging studies in the delayed phase depicted confluent, symmetric supra-tentorial white matter lesions in keeping with diffuse demyelinization. Restricted diffusion and metabolite abnormalities in magnetic resonance proton spectroscopy were also seen. The diagnosis of CO-mediated delayed post-hypoxic leukoencephalopathy was assumed after exclusion of other mimickers. Hyperbaric oxygen therapy was tentatively performed and the patient had a favorable clinical and radiological evolution.
authors.affiliation: Department of Neuroradiology, Hospital de Santa Maria (CHLN, EPE), Lisbon, Portugal ; Lisbon School of Medicine, Lisbon, Portugal.
authors.forename: Ana Filipa
authors.initials: AF
authors.lastname: Geraldo
authors.affiliation: Department of Neuroradiology, Hospital de Santa Maria (CHLN, EPE), Lisbon, Portugal.
authors.forename: Cristiana
authors.initials: C
authors.lastname: Silva
authors.affiliation: Department of Neurosciences (Neurology), Hospital de Santa Maria (CHLN, EPE), Lisbon, Portugal.
authors.forename: Dulce
authors.initials: D
authors.lastname: Neutel
authors.affiliation: Department of Neuroradiology, Hospital de Santa Maria (CHLN, EPE), Lisbon, Portugal ; Lisbon School of Medicine, Lisbon, Portugal.
authors.forename: Lia Lucas
authors.initials: LL
authors.lastname: Neto
authors.affiliation: Department of Neurosciences (Neurology), Hospital de Santa Maria (CHLN, EPE), Lisbon, Portugal ; Lisbon School of Medicine, Lisbon, Portugal.
authors.forename: Luísa
authors.initials: L
authors.lastname: Albuquerque
mesh_terms: D000208:Acute Disease; D000328:Adult; D001921:Brain / Q000473:pathology*; D002249:Carbon Monoxide Poisoning / Q000150:complications / Q000473:pathology / Q000503:physiopathology*; D003072:Cognition Disorders / Q000139:chemically induced* / Q000209:etiology; D003711:Demyelinating Diseases / Q000139:chemically induced / Q000473:pathology; D006801:Humans; D006931:Hyperbaric Oxygenation; D056784:Leukoencephalopathies / Q000139:chemically induced / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D001523:Mental Disorders / Q000139:chemically induced* / Q000209:etiology; D059906:Neuroimaging; D066244:Proton Magnetic Resonance Spectroscopy; D013997:Time Factors; D016896:Treatment Outcome
keywords: Carbon monoxide poisoning; delayed post-ischemic encephalopathy; diffusion magnetic resonance imaging; heroin inhalation syndrome; magnetic resonance spectroscopy; neurotoxicity syndromes