ABSTRACT
Delayed postanoxic encephalopathy causes relapse of cognitive impairment and movement deterioration in a few weeks after clinically complete recovery from initial anoxic or hypoxic insult. Delayed postanoxic encephalopathy is a rare condition, and its clinical symptoms are characterized by abulia, apathy, akinesia, confusion, agitation, parkinsonism, chorea, dystonia and/or progressive neurologic deficits. We reported two distinguished cases caused by carbon monoxide intoxication and mixed respiratory and metabolic lactic acidosis.
Subject(s)
Acidosis , Acidosis, Lactic , Apathy , Carbon Monoxide , Chorea , Dihydroergotamine , Dystonia , Neurologic Manifestations , Parkinsonian Disorders , RecurrenceABSTRACT
BACKGROUND: Delayed postanoxic encephalopathy (DPE) is a demyelinating disorder in which cognitive, behavioral and movement deteriorations relapse in a few weeks after a complete recovery from initial hypoxic injury. To our knowledge, there have been no reports describing the temporal change of diffusion-weighted imaging (DWI) findings in DPE. METHODS: In a patient with DPE, serial brain MRI including DWI was performed at admission, 1, 3, 5 and 11 months after the onset of DPE. In order to obtain apparent diffusion coefficient (ADC) value of the lesion, we selected the same axial slices of the serial DWI and placed eight regions of interest (ROIs) in the periventricular white matter. Mean ADC values of ROIs and ADC map were serially compared. RESULTS: Compared to normal value, the ADC values of ROIs remained low at admission and one-month follow-up (0.68+/-0.08 and 0.67 +/- 0.08 X 10(-3)mm2/s) and then continued to increase on the 3, 5 and 11-month follow-up (0.78+/-0.05, 0.80+/-0.05 and 0.87 +/- 0.11 X 10(-3)mm2/s). Abnormal low signal density in both periventricular white matters on initial ADC map also disappeared slowly. Serial ADC maps revealed continuing diffuse cytotoxic edema over 1 month after the onset of DPE. CONCLUSIONS: Delayed cytotoxic edema associated with delayed clinical symptom of DPE might implicate that possible pathogenesis of DPE is apoptosis. DWI including ADC map might be useful to detect apoptotic brain lesion.
Subject(s)
Humans , Apoptosis , Brain , Demyelinating Diseases , Diffusion , Edema , Follow-Up Studies , Magnetic Resonance Imaging , Recurrence , Reference ValuesABSTRACT
To obtain the basic data of prognosis of acute carbon monoxide (CO) intoxication, one hundred and sixteen cases of CO intoxication defined by carboxyhemoglobin (COHb) and admitted via emergency room of Yeungnam University Hospital from Oct. '85 to April' 89 have been clinically analyzed and evaluated, including delayed postanoxic encephalopathy (DPE) and the following results were obtained. 1. The ratio of male to female was 1:1.5 and mental state was drowsy mostly (26.2% of 116 cases) 2. The more disturbed the mental state, the more decreased was the arterial pH and PaCO₂, which may be the result of metabolic acidosis. 3. The early laboratory findings in patients of CO intoxication were as follows: leukocytosis-65.5%, increase of hematocrit-23.3%, hyperglycemia-19.8%, increase of GPT-19.8% increase of creatinine-0.9% and glucosuria-12.1%. 4. The early findings of EKG were abnormal in 35.3%: change of rhythm-25.0%, abnormal ST segment 15.5% (change of rhythm and abnormal ST segment-5.2%) but the conduction disorder was not present. 5. The abnormal EEG above mild degree was 93.1%, of which moderate was most frequent (80.2%). 6. The incidence of DPE was 7.8% among all admitted CO patients. DPE cases had long duration of exposure time (8 hours), severe leukocytosis (20,000) and an abnormal EEG (MA).