Kondo Akiko, Saito Yoshiaki, Seki Ayumi, Sugiura Chitose, Maegaki Yoshihiro, Nakayama Yusuke, Yagi Keiichi, Ohno Kousaku
Divisions of Child Neurology, Institute of Neurological Sciences, Faculty of Medicine, Tottori University, Japan.
Brain Dev. 2007 Apr;29(3):174-7. doi: 10.1016/j.braindev.2006.08.002. Epub 2006 Sep 27.
Here, we report the case of a five-year-old boy with carbonic monoxide (CO) poisoning. The patient initially recovered after the initiation of hyperbaric oxygen (HBO) therapy, but lethargy as well as visual and gait disturbances appeared two days later. Left hemiparesis and mood lability also subsequently appeared. Slow frontal activity was noted on electroencephalography, while fluid-attenuation inversion recovery and diffusion-weighted magnetic resonance imaging (MRI) revealed high signal-intensity lesions in the hippocampus and deeper layers of the occipital and frontal cerebral cortex. The neurological symptoms subsided gradually during the 10-day course of HBO therapy, but the left-hand paresis and quadrantic hemianopsia persisted, in association with impaired attention, slow mental processing, and incontinence. Lesions in the globus pallidum were noted on follow-up MRI at 14 days, and cortical lesions became evident as linear, low signal-intensity areas on T1-weighted imaging 4 months after presentation. Delayed neuropsychiatric syndrome in CO poisoning is rare in childhood, although children should be carefully monitored after CO exposure. The finding of cortical laminar necrosis in this patient is quite atypical in CO poisoning, and suggests a broader and previously nonpredicted pathomechanism in this condition.
在此，我们报告一例5岁一氧化碳（CO）中毒男孩的病例。患者在开始高压氧（HBO）治疗后最初恢复，但两天后出现嗜睡以及视觉和步态障碍。随后还出现了左侧偏瘫和情绪不稳定。脑电图显示额叶活动缓慢，而液体衰减反转恢复序列和扩散加权磁共振成像（MRI）显示海马体以及枕叶和额叶大脑皮质深层有高信号强度病变。在HBO治疗的10天疗程中，神经症状逐渐消退，但左手轻瘫和象限性偏盲持续存在，并伴有注意力受损、思维迟缓及大小便失禁。14天的随访MRI显示苍白球有病变，发病4个月后，皮质病变在T1加权成像上表现为线状低信号强度区域。尽管儿童在接触CO后应进行仔细监测，但CO中毒后的迟发性神经精神综合征在儿童期很少见。该患者出现皮质层状坏死的表现在CO中毒中相当不典型，提示这种情况下存在更广泛且先前未预测到的发病机制。
