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Assessment of damage to cerebral white matter fiber in the subacute phase after carbon monoxide poisoning using fractional anisotropy in diffusion tensor imaging

  • Diagnostic Neuroradiology
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Abstract

Introduction

Chronic neuropsychiatric symptoms after carbon monoxide (CO) poisoning are caused by demyelination of cerebral white matter fibers. We examined whether diffusion tensor imaging can sensitively represent damage to fibers of the centrum semiovale in the subacute phase after CO intoxication.

Methods

Subjects comprised 13 adult patients with CO poisoning, classified into three groups according to clinical behaviors: 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. Median fractional anisotropy (FA) and apparent diffusion coefficient (ADC) of the centrum semiovale bilaterally at 2 weeks were compared between these groups and a control group of ten healthy volunteers. 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 or detectable for all group P and group D patients but was undetectable for all patients assigned to group A. Low FA values in groups P and D displaying chronic neurological symptoms clearly differed from those in controls and group A without chronic neurological symptoms, but ADC showed no significant differences between patient groups.

Conclusions

MBP concentration at 2 weeks after CO inhalation confirmed a certain extent of demyelination in the central nervous system of patients who would develop chronic neurological symptoms. In these patients, FA sensitively represented damage to white matter fibers in the centrum semiovale in the subacute phase after CO intoxication.

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Abbreviations

CNS:

Central nervous system

CSF:

Cerebrospinal fluid

CO:

Carbon monoxide

COHb:

Carboxyhemoglobin

DNS:

Delayed neuropsychiatric sequelae

DTI:

Diffusion tensor imaging

FA:

Fractional anisotropy

ADC:

Apparent diffusion coefficient

GCS:

Glasgow coma scale

MBP:

Myelin basic protein

MRI:

Magnetic resonance imaging

ROI:

Region of interest

T2WI:

T2-weighted magnetic resonance imaging

References

  1. Weaver LK, Hopkins RO, Elliott G (1999) Carbon monoxide poisoning. N Engl J Med 340(16):1290

    Article  CAS  PubMed  Google Scholar 

  2. Choi IS (1983) Delayed neurologic sequelae in carbon monoxide intoxication. Arch Neurol 40(7):433–435

    CAS  PubMed  Google Scholar 

  3. Zhang J, Piantadosi CA (1992) Mitochondrial oxidative stress after carbon monoxide hypoxia in the rat brain. J Clin Invest 90(4):1193–1199

    Article  CAS  PubMed  Google Scholar 

  4. Thom SR (1990) Carbon monoxide-mediated brain lipid peroxidation in the rat. J Appl Physiol 68(3):997–1003

    CAS  PubMed  Google Scholar 

  5. Thom SR, Bhopale VM, Fisher D, Zhang J, Gimotty P (2004) Delayed neuropathology after carbon monoxide poisoning is immune-mediated. Proc Natl Acad Sci USA 101(37):13660–13665

    Article  CAS  PubMed  Google Scholar 

  6. Thom SR, Bhopale VM, Han ST, Clark JM, Hardy KR (2006) Intravascular neutrophil activation due to carbon monoxide poisoning. Am J Respir Crit Care Med 174(11):1239–1248

    Article  CAS  PubMed  Google Scholar 

  7. Ide T, Kamijo Y (2008) Myelin basic protein in cerebrospinal fluid: a predictive marker of delayed encephalopathy from carbon monoxide poisoning. Am J Emerg Med 26(8):908–912

    Article  PubMed  Google Scholar 

  8. Kamijo Y, Soma K, Ide T (2007) Recurrent myelin basic protein elevation in cerebrospinal fluid as a predictive marker of delayed encephalopathy after carbon monoxide poisoning. Am J Emerg Med 25(4):483–485

    Article  PubMed  Google Scholar 

  9. Pierpaoli C, Jezzard P, Basser PJ, Barnett A, Di Chiro G (1996) Diffusion tensor MR imaging of the human brain. Radiology 201:637–648

    CAS  PubMed  Google Scholar 

  10. Bammer R, Augustin M, Strasser-Fuchs S, Seifert T, Kapeller P, Stollberger R et al (2000) Magnetic resonance diffusion tensor imaging for characterizing diffuse and focal white matter abnormalities in multiple sclerosis. Magn Reson Med 44:583–591

    Article  CAS  PubMed  Google Scholar 

  11. Tievsky AL, Ptak T, Farkas J (1999) Investigation of apparent diffusion coefficient and diffusion tensor anisotropy in acute and chronic multiple sclerosis lesions. AJNR Am J Neuroradiol 20:1491–1499

    CAS  PubMed  Google Scholar 

  12. Chang KH, Han MH, Kim HS, Wie BA, Han MC (1992) Delayed encephalopathy after acute carbon monoxide intoxication: MR imaging features and distribution of cerebral white matter lesions. Radiology 184(1):117–122

    CAS  PubMed  Google Scholar 

  13. Otubo S, Shirakawa Y, Aibiki M, Nishiyama T, Maekawa S, Kikuchi K et al (2007) Magnetic resonance imaging could predict delayed encephalopathy after acute carbon monoxide intoxication. Chudoku Kenkyu 20(3):253–261 (Japanese)

    PubMed  Google Scholar 

  14. Parkinson RB, Hopkins RO, Cleavinger HB, Weaver LK, Victoroff J, Foley JF et al (2002) White matter hyperintensities and neuropsychological outcome following carbon monoxide poisoning. Neurology 58(10):1525–1532

    CAS  PubMed  Google Scholar 

  15. Sohn YH, Jeong Y, Kim HS, Im JH, Kim JS (2000) The brain lesion responsible for parkinsonism after carbon monoxide poisoning. Arch Neurol 57(8):1214–1218

    Article  CAS  PubMed  Google Scholar 

  16. Charlton RA, Barrick TR, McIntyre DJ, Shen Y, O'Sullivan M, Howe FA et al (2006) White matter damage on diffusion tensor imaging correlates with age-related cognitive decline. Neurology 66(2):217–222

    Article  CAS  PubMed  Google Scholar 

  17. Terajima K, Igarashi H, Hirose M, Matsuzawa H, Nishizawa M, Nakada T (2008) Serial assessments of delayed encephalopathy after carbon monoxide poisoning using magnetic resonance spectroscopy and diffusion tensor imaging on 3.0 T system. Eur Neurol 59(1–2):55–61

    Article  PubMed  Google Scholar 

  18. Lo CP, Chen SY, Chou MC, Wang CY, Lee KW, Hsueh CJ et al (2007) Diffusion-tensor MR imaging for evaluation of the efficacy of hyperbaric oxygen therapy in patients with delayed neuropsychiatric syndrome caused by carbon monoxide inhalation. Eur J Neurol 14(7):777–782

    Article  PubMed  Google Scholar 

  19. Chang CC, Lee YC, Chang WN, Chen SS, Lui CC, Chang HW, Lui WL et al (2010) Damage of white matter tract correlated with neuropsychological deficits in carbon monoxide intoxication after hyperbaric oxygen therapy. J Neurotrauma. doi:10.1089/neu.2008.0619

  20. Lin WC, Lu CH, Lee YC, Wang HC, Lui CC, Cheng YF et al (2009) White matter damage in carbon monoxide intoxication assessed in vivo using diffusion tensor MR imaging. AJNR Am J Neuroradiol 30(6):1248–1255

    Article  PubMed  Google Scholar 

  21. Vila JF, Meli FJ, Serqueira OE, Pisarello J, Lylyk P (2005) Diffusion tensor magnetic resonance imaging: a promising technique to characterize and track delayed encephalopathy after acute carbon monoxide poisoning. Undersea Hyperb Med 32(3):151–156

    CAS  PubMed  Google Scholar 

  22. Ernst A, Zibrak JD (1998) Carbon monoxide poisoning. N Engl J Med 339(22):1603–1608

    Article  CAS  PubMed  Google Scholar 

  23. Jain KK (2009) Carbon monoxide and other tissue poisons. In: Jain KK (ed) Textbook of hyperbaric medicine, 5th edn. Hogrefe and Huber, Cambridge, pp 43–133

    Google Scholar 

  24. Prockop LD, Chichkova RI (2007) Carbon monoxide intoxication: an updated review. J Neurol Sci 262(1–2):122–130

    Article  CAS  PubMed  Google Scholar 

  25. Kim JH, Chang KH, Song IC, Kim KH, Kwon BJ, Kim HC et al (2003) Delayed encephalopathy of acute carbon monoxide intoxication: diffusivity of cerebral white matter lesions. AJNR Am J Neuroradiol 24(8):1592–1597

    PubMed  Google Scholar 

  26. O'Donnell P, Buxton PJ, Pitkin A, Jarvis LJ (2000) The magnetic resonance imaging appearances of the brain in acute carbon monoxide poisoning. Clin Radiol 55(4):273–280

    Article  PubMed  Google Scholar 

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Acknowledgment

This study was supported in part by a Grant-in-Aid for Strategic Medical Science Research Center for Advanced Medical Science Research from the Ministry of Science, Education, Sports and Culture, Japan.

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We declare that we have no conflict of interest.

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Correspondence to Takaaki Beppu.

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Beppu, T., Nishimoto, H., Ishigaki, D. et al. Assessment of damage to cerebral white matter fiber in the subacute phase after carbon monoxide poisoning using fractional anisotropy in diffusion tensor imaging. Neuroradiology 52, 735–743 (2010). https://doi.org/10.1007/s00234-009-0649-x

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  • DOI: https://doi.org/10.1007/s00234-009-0649-x

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