Gürlek Yüksel Ebru, Taşkin E Oryal, Yilmaz Ovali Gülgün, Karaçam Melek, Esen Danaci Ayşen
Psikiyatri AD., Celal Bayar U Tip Fak., Manisa, Turkey.
Turk Psikiyatri Derg. 2007 Spring;18(1):80-6.
Carbon monoxide (CO) intoxication is usually a serious condition, which can result in neurological disturbances or death. In some patients with CO intoxication, but not usually, a biphasic pattern can be seen. In this condition, after antitoxic treatment, patients may completely recover and after a short recovery period, neurological and/or psychiatric symptoms appear again. This condition is known as delayed encephalopathy and its occurrence rate is between 0.06% and 11.8%. Herein, we report a case with delayed encephalopathy after CO intoxication, which began with neurological symptoms and continued with obsessive-compulsive disorder, depression, kleptomania, and psychotic disorder. The 41-year-old female patient had no psychiatric or neurological symptoms or disorders prior to CO intoxication. Increased signal intensity changes in the basal region of the left temporal lobe (including the cortex and subcortical white matter), globus pallidus (bilateral), and cerebellar cortical and subcortical white matter (bilaterally symmetrical) was detected on axial T2-weighted magnetic resonance imaging (MRI). In addition, there were atrophic changes in both cerebellar hemispheres. To the best of our knowledge, this is the first case of kleptomania described after CO intoxication in the literature. We discuss the organic etiology of kleptomania and the other psychiatric symptoms of this patient in the light of recent research. We concluded that the kleptomania seen in this patient was related to concurrent lesions in the temporal lobe and globus pallidus; in other words, her kleptomania may have been related to dysfunction simultaneously seen in both the temporolimbic and frontal-subcortical circuits.
一氧化碳(CO)中毒通常是一种严重的病症,可导致神经功能障碍或死亡。在一些CO中毒患者中,但并非常见情况,可出现双相模式。在这种情况下,经过解毒治疗后,患者可能完全康复,而在短暂的恢复期后,神经和/或精神症状会再次出现。这种情况被称为迟发性脑病,其发生率在0.06%至11.8%之间。在此,我们报告一例CO中毒后出现迟发性脑病的病例,该病例始于神经症状,随后出现强迫症、抑郁症、盗窃癖和精神障碍。这位41岁的女性患者在CO中毒之前没有精神或神经症状或疾病。在轴向T2加权磁共振成像(MRI)上检测到左侧颞叶基底区域(包括皮质和皮质下白质)、双侧苍白球以及双侧对称的小脑皮质和皮质下白质信号强度增加。此外,双侧小脑半球存在萎缩性改变。据我们所知,这是文献中首例描述的CO中毒后出现盗窃癖的病例。我们根据最近的研究讨论了该患者盗窃癖及其他精神症状的器质性病因。我们得出结论,该患者出现盗窃癖与颞叶和苍白球的并发病变有关;换句话说,她的盗窃癖可能与颞叶边缘系统和额叶 - 皮质下回路同时出现的功能障碍有关。