Presentation
The patient was found comatose at home. Intubated at the time of the CT scan.
Patient Data
There are attenuated surface sulci and features suggest cerebral edema and raised intracranial pressure. The basal ganglia and specifically the globi pallidi are normal. CT brain is otherwise unremarkable.
Case courtesy: Dr S. Palliam.
There is symmetric and bilaterally increased signal intensity within the globi pallidi, on T2 and T2 FLAIR imaging. There is associated restriction diffusion and reduced average diffusivity on ADC mapping. The features are consistent with bilateral, symmetric areas of infarction within the globi pallidi. The deep white matter is of normal signal intensity on MR imaging of the brain, with no other site of infarction/anoxic-ischemic injury identified.
Punctate hemosiderin blooming is identified on SWI.
There is normal enhancement post contrast administration.
MRI brain is otherwise normal.
Case Discussion
A suspected case of carbon monoxide poisoning (gas geyser syndrome). The patient remarkably improved from an initial GCS of 3/15 to a point of extubation within two days. We suspect the carboxyhemoglobin was rapidly eliminated due to the oxygenation with ventilation and prompt supportive treatment afforded to the patient. This most likely lead to a relatively favorable clinical outcome for the patient.
Toxic metabolic workup for recreational drugs, methanol, cyanide, and organophosphate poisoning proved negative.
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