Delayed Encephalopathy of Carbon Monoxide Intoxication: Case Report

Abstract

Scientific BACKGROUND: Carbon monoxide has been called a “great mimicker” and the clinical presentations may be nonspecific. For example; syncope, new-onset seizure, flu-like illness, headache, and chest pain. Delayed encephalopathy has also been seen in clinic.

OBJECTIVE: We aimed to adduce delayed encephalopathy of carbon monoxide intoxication clinic variability in our case.

CASE: Twenty-one years old, four months pregnant woman was admitted to our emergency room with confusion and diffuse rigidity. She was followed up in critical care unit of internal medicine because of CO intoxication which occured six days ago and hyperbaric oxygen therapy was given. This case was hospitalized in neurology for delayed encephalopathy due to CO intoxication. Presented neurological examination at admission revealed disorientation and limited cooperation. The patient had rigidity especially left upper and lower extremities. Hoffman sign was positive and she had clonus sign on the left side. Deep tendon reflexes were hyperactive at the lower extremities. Cranial magnetic resonance imaging (MRI) revealed bilateral hypointensitiy at T1-weighted sequence and hyperintensity at T2-weighted and FLAIR sequences in basal ganglions. After one month, these findings were continued in cranial MRI, but partially improved. Neurological examination of patient during delivery was completely normal.

CONCLUSION: A lot of neurological signs and symptoms can be seen in carbon monoxide intoxication and white matter lesions which were observed in cranial magnetic resonance imaging correlated with patient’s prognosis.