Hansen Marco Bo, Kondziella Daniel, Danielsen Else Rubæk, Larsen Vibeke Andree, Jansen Erik Christian, Hyldegaard Ole
Hyperbaric Oxygen Treatment Unit, Department of Anesthesia, Centre for Head and Orthopedics, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen DK-2100, Denmark.
J Med Case Rep. 2014 Jun 19;8:211. doi: 10.1186/1752-1947-8-211.
Predictive markers for long-term outcome in carbon monoxide-intoxicated patients with late encephalopathy are desired. Here we present the first data demonstrating a full reversibility pattern of specific brain substances measured by cerebral proton magnetic resonance spectroscopy in a carbon monoxide-intoxicated victim. This may provide clinicians with important information when estimating patient outcome.
We report the case of a 40-year-old Caucasian woman with severe carbon monoxide poisoning who was treated with five repetitive sessions of hyperbaric oxygen therapy in a multiplace chamber (100 percent oxygen with a ventilator, 90 minutes exposure to 2.8 atmospheres absolute). Initially, our patient recovered completely after three days of hospitalization, but became encephalopathic after a lucid interval of four weeks. An examination of the brain with cerebral proton magnetic resonance spectroscopy showed a dramatically decrease in N-acetylaspartate to total creatine ratios and elevated lactate levels in the gray matter. Subsequently, our patient received six additional sessions of hyperbaric oxygen therapy with only minimal recovery. At six-month follow-up our patient showed significant improvement in cognition and neuromuscular coordination. Extraordinarily, the cerebral proton magnetic resonance spectroscopy measurements at relapse compared to measurements at follow-up (217 days post insult) revealed full reversal of the severe abnormalities in mid-occipital gray matter and partial reversal in white matter.
The present case indicates that cerebral proton magnetic spectroscopy provides valuable information on brain metabolism in patients presenting with delayed encephalopathy after acute carbon monoxide intoxication. The full reversal of N-acetylaspartate to total creatine ratios in gray matter has, to our knowledge, never been described before and shows that severe, initial measurements may not predict poor long-term patient outcome.
对于患有迟发性脑病的一氧化碳中毒患者，我们需要能够预测其长期预后的标志物。在此，我们首次展示了通过脑质子磁共振波谱法测量的一名一氧化碳中毒受害者特定脑物质的完全可逆模式。这可能为临床医生评估患者预后提供重要信息。
我们报告了一名40岁白种女性的病例，她患有严重的一氧化碳中毒，在多人高压氧舱中接受了五次重复的高压氧治疗（使用呼吸机提供100%氧气，在2.8个绝对大气压下暴露90分钟）。最初，我们的患者在住院三天后完全康复，但在四周的清醒期后出现了脑病症状。通过脑质子磁共振波谱法对脑部进行检查发现，灰质中N - 乙酰天门冬氨酸与总肌酸的比值显著下降，乳酸水平升高。随后，我们的患者又接受了六次高压氧治疗，仅略有恢复。在六个月的随访中，我们的患者在认知和神经肌肉协调方面有了显著改善。特别的是，与随访时（受伤后217天）的测量结果相比，复发时的脑质子磁共振波谱法测量显示枕叶中部灰质的严重异常完全逆转，白质部分逆转。
本病例表明，脑质子磁共振波谱法为急性一氧化碳中毒后出现迟发性脑病的患者的脑代谢提供了有价值的信息。据我们所知，灰质中N - 乙酰天门冬氨酸与总肌酸比值的完全逆转此前从未被描述过，这表明最初的严重测量结果可能无法预测患者的长期不良预后。
