Satake Yuto, Mamiya Yoshimasa, Kano Shizuka, Akizuki Katsuhiko, Hashimoto Mamoru, Ikeda Manabu
Department of Psychiatry Osaka University Graduate School of Medicine Suita Japan.
Present address: Department of Child and Adolescent Psychiatry Osaka City General Hospital Osaka Japan.
PCN Rep. 2024 Jun 22;3(2):e218. doi: 10.1002/pcn5.218. eCollection 2024 Jun.
Delayed neuropsychiatric sequelae (DNS) is a syndrome that appears days to weeks after acute carbon monoxide (CO) poisoning. DNS shows various neuropsychiatric symptoms, such as mental deterioration and parkinsonism.
Our case was a 37-year-old male with schizophrenia. He attempted suicide by CO poisoning and was brought to our emergency department (Day 0). He was ventilated with normobaric oxygen therapy for 3 days and moved to the psychiatric ward with clear consciousness. We restarted antipsychotics, and he gradually presented akinesia and rigidity. Additionally, around Day 32, he showed disorganized behaviors, mental deterioration, incontinence, and gait disturbance. Brain magnetic resonance imaging (MRI) showed slightly abnormal findings on Day 35. Although we suspected DNS on the clinical course and the MRI findings, catatonia and side-effects of antipsychotics were also considered. Finally, electroencephalography (EEG) on Day 38 with apparent abnormalities, including diffuse slow waves, resulted in our diagnosis of DNS, and he underwent hyperbaric oxygen therapy. His condition was dramatically improved, and his diffuse slow waves on EEG disappeared on Day 83. We also followed his clinical presentations and brain MRI until 33 months. Throughout the whole follow-up, his cognition, movement, and psychiatric symptoms remained stable. However, his brain MRI showed progressive atrophy in bilateral frontal lobes and increasing white matter lesions throughout the whole course.
EEG, as well as brain MRI, may be crucial in the differential diagnosis of DNS in patients with complex conditions involving medications and severe mental illnesses.
迟发性神经精神后遗症（DNS）是一种在急性一氧化碳（CO）中毒数天至数周后出现的综合征。DNS表现出各种神经精神症状，如精神衰退和帕金森综合征。
我们的病例是一名37岁的精神分裂症男性。他企图通过一氧化碳中毒自杀，被送至我们的急诊科（第0天）。他接受了常压氧疗通气3天，意识清醒后转至精神科病房。我们重新开始使用抗精神病药物，他逐渐出现运动不能和僵硬。此外，在第32天左右，他出现了行为紊乱、精神衰退、大小便失禁和步态障碍。脑部磁共振成像（MRI）在第35天显示有轻微异常表现。尽管根据临床病程和MRI表现我们怀疑是DNS，但也考虑了紧张症和抗精神病药物的副作用。最后，第38天的脑电图（EEG）出现明显异常，包括弥漫性慢波，从而确诊为DNS，他接受了高压氧治疗。他的病情显著改善，脑电图上的弥漫性慢波在第83天消失。我们还对他的临床表现和脑部MRI进行了长达33个月的随访。在整个随访过程中，他的认知、运动和精神症状保持稳定。然而，他的脑部MRI显示双侧额叶逐渐萎缩，整个病程中白质病变不断增加。
脑电图以及脑部MRI在涉及药物和严重精神疾病的复杂情况下对DNS的鉴别诊断可能至关重要。
