Combined treatment of methylprednisolone pulse and memantine hydrochloride prompts recovery from neurological dysfunction and cerebral hypoperfusion in carbon monoxide poisoning: a case report.

A 49-year-old healthy man developed sudden unconsciousness under inadequate ventilation. Blood gas analysis showed carboxyhemoglobin of 7.3%. After normobaric oxygen therapy, he recovered completely 7 days later. At 3 weeks after carbon monoxide (CO) exposures, memory and gait disturbances appeared. Neurological examination revealed Mini-Mental State Examination (MMSE) score of 5 of 30 points, leg hyper-reflexia with Babinski signs, and Parkinsonism. Brain fluid-attenuated inversion recovery imaging disclosed symmetric hypointense lesions in the thalamus and the globus pallidus, and hyperintense lesions in the cerebral white matter. Brain single-photon emission tomography (SPECT) scanning with (99m)Technesium-ethyl cysteinate dimer displayed marked hypoperfusion in the cerebellum, the thalamus, the basal ganglia, and the entire cerebral cortex. He was diagnosed as CO poisoning and treated with hyperbaric oxygen therapy. The neurological deficits were not ameliorated. At 9 weeks after neurological onset, methylprednisolone (1000 mg/day, intravenous, 3 days) and memantine hydrochloride (20 mg/day, per os) were administered. Three days later, MMSE score was increased from 3 to 20 points. Neurological examination was normal 3 weeks later. Brain SPECT exhibited 20% increase of regional cerebral blood flows in the cerebellum, the thalamus, the basal ganglia, and the entire cerebral cortex. These clinicoradiological changes supported that the treatment with steroid pulse and memantine hydrochloride could prompt recovery from neurological dysfunction and cerebral hypoperfusion. Further clinical trials are warranted whether such combined therapy can attenuate neurological deficits and cerebral hypoperfusion in patients with CO poisoning.

[Predicting of the period of recurrent for a post-operative glioblastoma after radiochemotherapy using 201TlCl SPECT].

After radiochemotherapy for a post-operative glioblastoma multiforme (GB), the majority of patients return at a later date with a recurrent. To assess whether 201TlCl uptake can be used as a prognostic indicator in patients with GB, we measured the ratio of 201TlCl uptake in tumor to 201TlCl uptake in normal brain (TL index) in 10 patients at the end of radiochemotherapy and followed all the patients until they returned with a recurrent. The TL indices at the end of radiochemotherapy indicated 1.36 to 6.82 (mean +/- SD; 3.59 +/- 1.84), and the terms of tumor recurrent were 3-12 months (5.55 +/- 3.10 month). There was a significant negative correlation between the TL indices and the terms of tumor recurrent (y = -1.28x + 10.14, r = 0.760, p < 0.01). Especially, three cases indicated less than 2.0 did not returned with a recurrent in 8 months and 7 cases more than 2.0 returned with a recurrent in 5 months. This study resulted that 201TlCl SPECT was clinically useful to predict the period of recurrent for GB.