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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 24:1592-1597, September 2003
© 2003 American Society of Neuroradiology

BRAIN

Delayed Encephalopathy of Acute Carbon Monoxide Intoxication: Diffusivity of Cerebral White Matter Lesions

Ji-hoon Kim^a, Kee-Hyun Chang^a,b,c, In Chan Song^a,b, Keon Ha Kim^a, Bae Ju Kwon^a, Hyo-Cheol Kim^a, Jae Hyoung Kim^a and Moon Hee Han^a,b,c

^a Department of Radiology, Seoul National University College of Medicine, Korea
^b Institute of Radiation Medicine, Seoul National University College of Medicine, Korea
^c Neuroscience Research Institute, Seoul National University College of Medicine, Korea

Address reprint requests to Kee-Hyun Chang, Department of Radiology, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul, 110–744, Korea

BACKGROUND AND PURPOSE: Carbon monoxide intoxication has delayed effects on the cerebral white matter characterized by bilateral, confluent lesions that reflect diffuse demyelination. To increase our understanding of this process, we assessed the diffusion characteristics of these lesions.

METHODS: Five consecutive patients with delayed encephalopathy of CO intoxication were examined with diffusion MR imaging. Diffusion-weighted images (DWIs) were obtained 25–95 days after their exposure to CO and during a relapse of neuropsychiatric symptoms, which occurred after an initial recovery. Imaging was performed at 1.5 T by using a spin-echo echo-planar sequence with diffusion gradients of 0, 500, and 1000 s/mm². DWIs and apparent diffusion coefficient (ADC) maps were visually evaluated, and mean ADCs were calculated from the periventricular white matter and the centrum semiovale, where confluent hyperintensity was seen on T2-weighted images. Findings were compared with those of normal-looking white matter.

RESULTS: In all five patients, both T2-weighted images and DWIs showed the white matter lesions as bilateral, diffuse, confluent areas of hyperintensity in the periventricular white matter and centrum semiovale. On ADC maps, these lesions were isointense, with focal areas of hypointensity (n = 4) or diffuse hypointensity (n = 1). Mean ADC values of the white matter lesions were significantly lower than those of normal-looking white matter, regardless of their isointensity or hypointensity on ADC maps (P < .05).

CONCLUSION: Bilateral, confluent, white matter lesions in patients with delayed encephalopathy of CO intoxication show decreased diffusivity.

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