Cerebral proton magnetic resonance spectroscopy demonstrates reversibility of N-acetylaspartate/creatine in gray matter after delayed encephalopathy due to carbon monoxide intoxication
- Authors:
- Subtitle:
- a case report
- DOI:
- 10.1186/1752-1947-8-211
- Abstract:
- INTRODUCTION: Predictive markers for long-term outcome in carbon monoxide-intoxicated patients with late encephalopathy are desired. Here we present the first data demonstrating a full reversibility pattern of specific brain substances measured by cerebral proton magnetic resonance spectroscopy in a carbon monoxide-intoxicated victim. This may provide clinicians with important information when estimating patient outcome. CASE PRESENTATION: We report the case of a 40-year-old Caucasian woman with severe carbon monoxide poisoning who was treated with five repetitive sessions of hyperbaric oxygen therapy in a multiplace chamber (100 percent oxygen with a ventilator, 90 minutes exposure to 2.8 atmospheres absolute). Initially, our patient recovered completely after three days of hospitalization, but became encephalopathic after a lucid interval of four weeks. An examination of the brain with cerebral proton magnetic resonance spectroscopy showed a dramatically decrease in N-acetylaspartate to total creatine ratios and elevated lactate levels in the gray matter. Subsequently, our patient received six additional sessions of hyperbaric oxygen therapy with only minimal recovery. At six-month follow-up our patient showed significant improvement in cognition and neuromuscular coordination. Extraordinarily, the cerebral proton magnetic resonance spectroscopy measurements at relapse compared to measurements at follow-up (217 days post insult) revealed full reversal of the severe abnormalities in mid-occipital gray matter and partial reversal in white matter. CONCLUSIONS: The present case indicates that cerebral proton magnetic spectroscopy provides valuable information on brain metabolism in patients presenting with delayed encephalopathy after acute carbon monoxide intoxication. The full reversal of N-acetylaspartate to total creatine ratios in gray matter has, to our knowledge, never been described before and shows that severe, initial measurements may not predict poor long-term patient outcome.
- Type:
- Journal article
- Language:
- English
- Published in:
- Journal of Medical Case Reports, 2014, Vol 8, p. 1-5
- Keywords:
- Case Reports; Journal Article; Adult; Aspartic Acid; Brain; Brain Diseases; Carbon Monoxide Poisoning; Creatine; Female; Humans; Magnetic Resonance Imaging; Neuroimaging; Proton Magnetic Resonance Spectroscopy
- Main Research Area:
- Medical science
- Publication Status:
- Published
- Review type:
- Peer Review
- Submission year:
- 2014
- Scientific Level:
- Scientific
- ID:
- 268476467
