Measuring Optic Nerve Sheath Diameter with Bedside Ocular Ultrasonography in Patients with Carbon Monoxide Poisoning.

OBJECTIVE: To investigate the relationship between optic nerve sheath diameter (ONSD) and clinical and carboxyhemoglobin levels in patients with carbon monoxide poisoning. MATERIAL AND METHODS: This prospective cross-sectional study enrolled 55 consecutive adult patients with carbon monoxide poisoning. The demographic and clinical characteristics of the patients and the diameters of the optic nerve sheaths of both eyes of those patients at the time of admission and at the 6th hour after receiving 100% oxygen therapy and/or hyperbaric oxygen therapy were determined. The ages, genders, arterial blood pressure values, symptoms, carboxyhemoglobin levels, and bilateral ONSD values (measured sonographically before and after the oxygen therapy) of the patients were recorded in a data collection form. RESULTS: Measurements of ONSD before and after treatment were observed significantly (P = .01). Significant decreases were observed in ONSDs after treatment (P < .05). However, no significant difference was observed between ONSDs at the time of admission and after the treatment of patients receiving 2-hour single-session hyperbaric oxygen therapy and 100% oxygen therapy with a reservoir mask (P > .05). CONCLUSION: The changing of ONSD, which is an indirect indicator of increased intracranial pressure, is a promising method to use at emergency service for patients with carbon monoxide poisoning.

Correlation of computed tomography, magnetic resonance imaging and clinical outcome in acute carbon monoxide poisoning / Correlação de tomografia computadorizada, ressonância magnética e resultados clínicos em intoxicação aguda por monóxido de carbono

Abstract Background and objectives: Carbon monoxide is a toxic gas for humans and is still a silent killer in both developed and developing countries. The aim of this case series was to evaluate early radiological images as a predictor of subsequent neuropsychological sequelae, following carbon monoxide poisoning. Case 1: After carbon monoxide exposure, early computed tomography scans and magnetic resonance imaging findings of a 52-year-old woman showed bilateral lesions in the globus pallidus. This patient was discharged and followed for 90 days. The patient recovered without any neurological sequela. Case 2: In a 58-year-old woman exposed to carbon monoxide, computed tomography showed lesions in bilateral globus pallidus and periventricular white matter. Early magnetic resonance imaging revealed changes similar to that like in early tomography images. The patient recovered and was discharged from hospital. On the 27th day of exposure, the patient developed disorientation and memory impairment. Late magnetic resonance imaging showed diffuse hyperintensity in the cerebral white matter. Conclusion: White matter lesions which progress to demyelination and end up in neuropsychological sequelae cannot always be diagnosed by early computed tomography and magnetic resonance imaging in carbon monoxide poisoning.

Resumo Justificativa e objetivos: Monóxido de carbono é um gás tóxico para os seres humanos, além de ser um assassino silencioso tanto em países desenvolvidos quanto em desenvolvimento. O objetivo desta série de casos foi avaliar as imagens radiológicas iniciais como um preditivo de sequelas neuropsicológicas decorrentes de intoxicação por monóxido de carbono. Caso 1: Após exposição ao monóxido de carbono, os achados iniciais em tomografias computadorizadas e ressonâncias magnéticas de uma mulher de 52 anos mostraram lesões em globo pálido bilateralmente. A paciente recebeu alta e foi acompanhada por 90 dias. Recuperou-se sem sequelas neurológicas. Caso 2: Paciente do sexo feminino, 58 anos, exposta ao monóxido de carbono. A tomografia computadorizada mostrou lesões em globo pálido, bilateralmente, e substância branca periventricular. A ressonância magnética inicial revelou alterações semelhantes àquelas em tomografias precoces. A paciente se recuperou e recebeu alta. No 27° dia de exposição, evoluiu com desorientação e perda de memória. Ressonância magnética posterior mostrou hiperintensidade difusa da substância branca cerebral. Conclusão: As lesões da substância branca que progridem para desmielinização e resultam em sequelas neuropsicológicas nem sempre podem ser diagnosticadas em tomografias e ressonâncias iniciais em casos de intoxicação por monóxido de carbono.

Correlation of computed tomography, magnetic resonance imaging and clinical outcome in acute carbon monoxide poisoning.

BACKGROUND AND OBJECTIVES: Carbon monoxide is a toxic gas for humans and is still a silent killer in both developed and developing countries. The aim of this case series was to evaluate early radiological images as a predictor of subsequent neuropsychological sequelae, following carbon monoxide poisoning. CASE 1: After carbon monoxide exposure, early computed tomography scans and magnetic resonance imaging findings of a 52-year-old woman showed bilateral lesions in the globus pallidus. This patient was discharged and followed for 90 days. The patient recovered without any neurological sequela. CASE 2: In a 58-year-old woman exposed to carbon monoxide, computed tomography showed lesions in bilateral globus pallidus and periventricular white matter. Early magnetic resonance imaging revealed changes similar to that like in early tomography images. The patient recovered and was discharged from hospital. On the 27th day of exposure, the patient developed disorientation and memory impairment. Late magnetic resonance imaging showed diffuse hyperintensity in the cerebral white matter. CONCLUSION: White matter lesions which progress to demyelination and end up in neuropsychological sequelae cannot always be diagnosed by early computed tomography and magnetic resonance imaging in carbon monoxide poisoning.