Presentation
Patient found unconscious in a poorly ventilated room near a gas heater two days ago.
Patient Data
There is a bilateral symmetrical abnormal signal involvement of the globi pallidi which appear of high signal T2/FLAIR, low signal on T1 with restricted diffusion.
There is also a T2/FLAIR hyperintensity in the right frontal subcortical white matter in keeping with acute demyelination.
No abnormal enhancement on post-contrast sequence and no signal drop-out on T2 GRE.
Case Discussion
Carbon monoxide poisoning may result in an anoxic-ischemic encephalopathy, with acute as well as delayed effects.
The clinical presentation is characterized by acute toxicity, presenting as nausea, headache, cognitive impairment, loss of consciousness, seizure and coma.
Neurological sequelae are dementia, memory deficits, personality disturbance, parkinsonian-like symptoms.
Computed Tomography is usually negative at early stage; sometimes symmetric hypoattenuation in globi pallidi and diffuse hypoattenuation of the cerebral white matter can be described.
MR is a useful imaging technique, and is frequently positive at early stage of poisoning.
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