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1H-magnetic resonance spectroscopy indicates damage to cerebral white matter in the subacute phase after CO poisoning
  1. Takaaki Beppu1,2,
  2. Hideaki Nishimoto1,3,
  3. Shunrou Fujiwara1,3,
  4. Kaoru Kudo4,
  5. Katsumi Sanjo4,
  6. Shinsuke Narumi5,
  7. Hirotaka Oikawa6,
  8. Makoto Onodera6,
  9. Kuniaki Ogasawara1,
  10. Makoto Sasaki3
  1. 1Department of Neurosurgery, Iwate Medical University, Morioka, Japan
  2. 2Departement of Hyperbaric Medicine, Iwate Medical University, Morioka, Japan
  3. 3Advanced Medical Research Center, Iwate Medical University, Morioka, Japan
  4. 4Department of Psychiatry, Iwate Medical University, Morioka, Japan
  5. 5Department of Neurology, Iwate Medical University, Morioka, Japan
  6. 6Iwate Prefectural Advanced Critical Care and Emergency, Morioka, Japan
  1. Correspondence to Dr Takaaki Beppu, Departments of Neurosurgery and Hyperbaric Medicine, Iwate Medical University, Uchimaru 19-1, Morioka 020-8505, Japan; tbeppu{at}


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
  • demyelination
  • 1H-magnetic resonance spectroscopy
  • myelin basic protein
  • cerebral metabolism
  • image analysis
  • MRS
  • neurotoxicology

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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.