Objective The authors examined whether 1H-magnetic resonance spectroscopy (MRS) can identify damage to the centrum semiovale in the subacute phase after CO exposure.
Methods Subjects comprised 29 adult patients who were treated with hyperbaric oxygenation within a range of 4–95 h (mean 18.7 h) after CO exposure. Subjects were classified into three groups according to clinical behaviours: Group A, patients with transit acute symptoms only; Group P, patients with persistent neurological symptoms; and Group D, patients with ‘delayed neuropsychiatric sequelae’ occurring after a lucid interval. MRS of bilateral centrum semiovale was performed 2 weeks after CO inhalation for all patients and 13 healthy volunteers. The mean ratios of choline-containing compounds/creatine (meanCho/Cr) and N-acetylaspartate/Cr (meanNAA/Cr) for bilateral centrum semiovale were calculated and compared between the three CO groups and controls. Myelin basic protein (MBP) concentration in cerebrospinal fluid was examined at 2 weeks to evaluate the degree of demyelination in patients.
Results MBP concentration was abnormal for almost all patients in Groups P and D, but was not abnormal for any Group A patients. The meanCho/Cr ratios were significantly higher in Groups P and D than in Group A. No significant difference in meanNAA/Cr ratio was seen between the three pathological groups and controls. A significant correlation was identified between MBP and meanCho/Cr ratio.
Conclusions These results suggest that the Cho/Cr ratio in the subacute phase after CO intoxication represents early demyelination in the centrum semiovale, and can predict chronic neurological symptoms.
- Carbon monoxide poisoning
- delayed neuropathy
- 1H-magnetic resonance spectroscopy
- myelin basic protein
- cerebral metabolism
- image analysis
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Funding This study was supported in part by Grant-in-Aid for Scientific Research (C) and for Strategic Medical Science Research Center for Advanced Medical Science Research from the Ministry of Science, Education, Sports and Culture, Japan.
Competing interests None.
Patient consent Obtained.
Ethics approval Ethics approval was provided by the Ethics Committee at Iwate Medical University, Morioka, Japan.
Provenance and peer review Not commissioned; externally peer reviewed.