Kondo T, Ikeda T, Mogami H, Miura T, Mitomo M, Shimazaki S, Sugimoto T
No To Shinkei. 1978 May;30(5):525-31.
Eleven cases of acute carbon-monoxide poisoning in various stages were observed with the computerized tomography for 17 times and analysed their correlation between intracranial lesion and their clinical courses. Five of 11 cases revealed characterististic pathologic findings in CT scan, however complete recovery of consciousness was observed in only 4 of 6 cases with normal CT findings. In early stage of acute carbon-monoxide poisoning, CT scans showed typical diffuse subcortical low absorption with no obvious ventricular dilatation. The entity of this typical finding was supposed to be the so called "vasogenic edema" attributed to increased extracellular fluid caused by increased permeability of vessels due to hypoxic process of the poisoning. While this diffuse subcortical edema was subsiding gradually in about 2 weeks, progressive brain atrophy was supervening and resulted finally in severe dilatation of the ventricular system. In spite of two exceptional cases of vegetative state with normal CT scan in early stage seemed suggestive of poor prognosis in most of cases. Pathogenesis of subcortical brain edema and the effect of hyperbaric therapy in the cases of acute carbon monoxide poisoning were also discussed.
对11例处于不同阶段的急性一氧化碳中毒患者进行了17次计算机断层扫描，分析了颅内病变与临床病程之间的相关性。11例患者中有5例在CT扫描中显示出特征性病理表现，然而，6例CT表现正常的患者中只有4例意识完全恢复。在急性一氧化碳中毒早期，CT扫描显示典型的弥漫性皮质下低密度影，脑室无明显扩张。这种典型表现的实质被认为是所谓的“血管源性水肿”，是由于中毒缺氧过程导致血管通透性增加，细胞外液增多所致。当这种弥漫性皮质下水肿在约2周内逐渐消退时，进行性脑萎缩开始出现，最终导致脑室系统严重扩张。尽管有两例早期CT扫描正常但处于植物状态的例外情况，但大多数病例似乎提示预后不良。还讨论了急性一氧化碳中毒病例中皮质下脑水肿的发病机制和高压氧治疗的效果。
