Article Figures & Data
Figures
- Fig 1.
Location of the WM regions of interest in a patient with CO intoxication. A, WM of temporal lobes. B, WM of orbitofrontal, occipital, anterior, and posterior limbs of the internal capsule. C, Genu and splenium of the corpus callosum. D, WM of the frontal and parietal lobes.
- Fig 2.
A 57-year-old man with delayed neuropsychiatric syndrome after CO intoxication (upper) and a healthy control (lower). A and B, Axial T2-weighted images (A) and FLAIR MR images (B) show symmetric necrosis of the bilateral globus pallidus and extensive hyperintensity of the subcortical WM. C, ADC map. D, The FA map of DTI reveals clearly reduced fiber integrity of the corresponding WM. The color bar represents the FA values.
- Fig 3.
Scatterplots show the FA value of average overall WM versus MMSE (A) and digit span backward results (B) in patients with CO intoxication.
Tables
Patient/Age (yr)/Sex Neurologic Features WM Involved in Delayed Encephalopathy on MRI Time (days) Lucid To MRI To Testing 1/57/M Acute: coma, conscious in 2 days; delayed: impaired memory, personality change, parkinsonism, general weakness Globus pallidus, frontal, parietal, temporal, occipital 12 12 22 2/44/M Acute: coma, conscious in ≤1 day; delayed: impaired cognition and memory Globus pallidus, frontal, parietal 42 83 44 3/26/F Acute: coma, conscious in a few days; delayed: impaired memory, parkinsonism, amnesia, bad temper Frontal, parietal 13 120 115 4/35/M Acute: coma; delayed: impaired memory, inattention, personality change, amnesia Parietal, occipital 20 31 24 5/34/M Acute: coma, conscious in 1 week; delayed: ataxia, impaired memory, ideomotor apraxia Globus pallidus, frontal, parietal 7 393 383 6/62/M Acute: coma, conscious in ≤1 day; delayed: confusion, impaired cognition, apraxia, amnesia, parkinsonism Globus pallidus, frontal, parietal, occipital 25 4 3 7/41/F Acute: coma; delayed: parkinsonism, dysmetria, dyssynergia, urine retention, difficulty defecating Globus pallidus, frontal, parietal 7 4 15 8/24/F Acute: coma; delayed: ataxia, impaired cognition Globus pallidus, frontal, parietal 20 107 106 9/41/F Acute: coma; delayed: disorientation, incoherent speech, dysexecution, behavioral changes, acute dystonia Globus pallidus, frontal, parietal 19 26 8 10/43/M Acute: coma, conscious in ≤1 day; delayed: impaired memory and cognition, parkinsonism Globus pallidus, frontal, parietal 17 30 18 11/48/M Acute: disturbed consciousness in 1 day; delayed: depression, parkinsonism Globus pallidus 10 3 2 12/36/F Acute: disturbed consciousness in 1 day; delayed: amnesia, apraxia Globus pallidus, parietal, occipital 23 414 414 13/37/F Acute: coma; delayed: impaired memory and cognition Frontal, parietal, occipital 6 55 7 14/41/M Acute: coma; delayed: ataxia, disorientation, urinary incontinence No obvious lesion 15 442 423 Note:—MRI indicates MR imaging.
- Table 2:
Mean FA values of the selected WM areas from CO intoxication in patients and controls
Region Mean ± SD, × 10−3 P* Patients (n = 14) Control Subjects (n = 16) Corpus callosum, genu 614.3 ± 97.5 750.6 ± 40.2 <.001* Corpus callosum, splenium 725.7 ± 10.8 791.3 ± 58.0 .044* Anterior limb internal capsule, L 536.4 ± 12.6 563.8 ± 54.8 .461 Anterior limb internal capsule, R 530.7 ± 82.5 573.8 ± 32.6 .085 Posterior limb internal capsule, L 627.9 ± 46.4 655.0 ± 59.9 .181 Posterior limb internal capsule, R 621.4 ± 46.9 651.3 ± 41.8 .086 Orbitofrontal, L 343.6 ± 71.3 438.1 ± 43.1 <.001* Orbitofrontal, R 357.9 ± 75.2 435.6 ± 36.7 .002* High frontal, L 322.8 ± 60.0 411.3 ± 38.8 <.001* High frontal, R 312.2 ± 46.5 408.1 ± 22.2 <.001* Parietal, L 380.9 ± 80.8 456.9 ± 46.4 <.001* Parietal, R 361.2 ± 66.8 465.0 ± 38.1 <.001* Occipital, L 406.4 ± 66.6 442.5 ± 42.7 .063 Occipital, R 409.3 ± 63.3 446.9 ± 61.3 .110 Temporal, L 383.6 ± 63.6 432.5 ± 52.1 .028* Temporal, R 346.4 ± 67.1 431.3 ± 44.4 <.001* All WM areas 456.2 ± 39.7 522.1 ± 17.8 <.001* Note:—L indicates left; R, right; FA, fractional anisotropy; WM, white matter; CO, carbon monoxide.
* <.05 indicates significance.
- Table 3:
Mean ADC values of the selected WM areas from CO intoxication in patients and controls
Region Mean ± SD, mm2s−1 × 10−12 P* Patients (n = 14) Control Subjects (n = 16) Corpus callosum, genu 1006.0 ± 117.1 851.3 ± 59.9 <.001* Corpus callosum, splenium 1336.0 ± 186.2 784.1 ± 79.3 .023* Anterior limb internal capsule, L 837.7 ± 73.1 750.4 ± 47.9 .001* Anterior limb internal capsule, R 839.4 ± 77.7 731.1 ± 46.6 <.001* Posterior limb internal capsule, L 771.9 ± 72.6 686.3 ± 60.3 .001* Posterior limb internal capsule, R 750.4 ± 33.6 687.3 ± 50.2 <.001* Orbitofrontal, L 942.1 ± 75.4 838.9 ± 77.8 .001* Orbitofrontal, R 949.3 ± 72.7 878.8 ± 52.8 .005* High frontal, L 852.1 ± 95.4 731.3 ± 63.9 <.001* High frontal, R 848.1 ± 105.0 745.6 ± 53.8 .005* Parietal, L 765.7 ± 72.2 707.8 ± 54.3 .018* Parietal, R 796.4 ± 74.2 708.4 ± 55.3 <.001* Occipital, L 825.2 ± 50.6 750.4 ± 51.0 <.001* Occipital, R 818.1 ± 57.9 748.6 ± 70.7 .007* Temporal, L 859.1 ± 80.1 788.7 ± 49.1 .006* Temporal, R 895.0 ± 44.8 792.1 ± 59.2 <.001* All WM areas 880.8 ± 123.3 761.3 ± 38.6 .001* Note:—ADC indicates apparent diffusion coefficient.
* <.05 indicates significance.
- Table 4:
Spearman rank correlation coefficients for neuropsychological results and FA values
Region MMSE Score Digit Span Verbal Fluency Forward Backward Animals Vegetables Corpus callosum, genu 0.462 −0.192 0.272 −0.099 0.327 Corpus callosum, splenium 0.291 −0.136 0.577* −0.164 0.112 Anterior limb internal capsule, L 0.482 −0.199 0.250 −0.044 0.234 Anterior limb internal capsule, R 0.501 0.031 0.384 −0.011 0.223 Posterior limb internal capsule, L 0.407 −0.343 0.046 −0.060 0.348 Posterior limb internal capsule, R 0.532 −0.269 0.295 0.135 0.201 Orbitofrontal, L 0.755* −0.009 0.669* −0.186 0.410 Orbitofrontal, R 0.683* −0.027 0.675* −0.156 0.323 High frontal, L −0.035 −0.410 0.265 0.102 0.147 High frontal, R −0.077 −0.476 0.198 0.082 0.235 Parietal, L 0.470 −0.058 0.697* −0.033 0.211 Parietal, R 0.402 −0.175 0.588* −0.153 0.273 Occipital, L 0.257 0.120 0.480 −0.185 0.069 Occipital, R 0.448 0.040 0.484 −0.022 0.301 Temporal, L 0.393 −0.289 0.543* −0.229 −0.009 Temporal, R 0.172 −0.335 0.598* −0.290 −0.022 All WM areas 0.631* −0.179 0.795* −0.079 0.453 Note:—MMSE indicates Mini-Mental State Examination.
* <.05 indicates significance.
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