A Rare Case of Acute Carbon Monoxide Toxicity Mimicking Stroke and Successfully Managed with Hyperbaric Oxygen Therapy

Abstract

Acute carbon monoxide (CO) poisoning significantly impacts neurological function, stemming from incomplete combustion of carbon-containing materials; this poses a substantial risk. Symptoms range from mild headaches to severe neurological complications, complicating diagnosis. Primary treatment involves supplemental oxygen via a non-rebreather mask. Hyperbaric oxygen therapy (HBOT), though debated, initiated within 6 hours, may enhance carboxyhaemoglobin (CO-Hb) elimination and tissue oxygenation, even with decreased CO-Hb levels. We report an 82-year-old female patient who presented to the emergency department of a tertiary care hospital in Muscat, Oman, in 2024 with symptoms initially suggestive of a cerebrovascular event. However, further history and examination revealed indications of acute CO poisoning, likely due to exposure to a charcoal-burning heater. Despite stable vital signs, her CO-Hb and lactates levels were high. Treatment with normobaric oxygen therapy resulted in some improvement, but significant neurological recovery was achieved with HBOT. This case represents the first documented instance of successful HBOT treatment for acute CO toxicity in Oman.

Keywords: Carbon Monoxide Poisoning; Carboxyhemoglobin; Case Report; Hyperbaric Oxygen Therapy; Neurological Manifestation; Oman; Poisoning.