The magnetic resonance imaging appearances of the brain in acute carbon monoxide poisoning

Abstract

Aims: To describe the magnetic resonance imaging (MRI) appearances of the brain in acute carbon monoxide poisoning, the commonest cause of accidental poisoning in Europe and the U.S.A. To attempt to correlate the imaging findings with patient outcome as an aid to prognosis.

Materials and methods: Brain MRI was performed on 19 consecutive patients, who had sustained acute carbon monoxide poisoning, as soon as possible after their referral to the regional Hyperbaric Unit at the Royal Hospital, Haslar. All patients were unconscious on arrival, and had received at least one treatment with hyperbaric oxygen by the time of first MR. The imaging findings were analysed independently by two experienced MR radiologists, with a third radiologist arbitrating on discrepant results.

Results: Thirteen male and six female patients, age range 21-70 years (mean 38.7 years) underwent MR an average of 35.6 h (range 6-126 h) following presentation at the referring centre. MR (at 0.5T) revealed abnormalities in the following areas: globus pallidus (n = 12); other basal ganglia [ n = 5: entire lentiform (globus pallidus and putamen), putamen alone, caudate nucleus, thalamus]; white matter (n = 6: periventricular, subcortical, other); cerebral cortex (n = 5), either localized or general; medial temporal lobe in the region of the hippocampus (n = 4). The majority of the patients with hyperintensity in the region of the hippocampus (n = 3) had no other area of cortical involvement. Two patients showed abnormalities in the cerebellum. Normal appearances were seen on the initial MR in seven patients.

Conclusion: The appearances of the brain following acute CO poisoning are varied, and have previously been the subject of case reports or small studies, most of which have have addressed the delayed sequelae of this condition. This study, the first large series undertaken in the acute phase, confirms that, although the globus pallidus is the commonest site of abnormality in the brain, the effects of CO poisoning are widespread. The extent of damage correlates with clinical outcome, and therefore aids management and prognosis.