Carbon dioxide poisoning on imaging1/16/2024 ![]() ![]() Firstly, past medical history of the patient revealed that she had been under treatment with risperidone, amitriptyline, and escitalopram for paranoid schizophrenia and bipolar disorder, which can give rise to drug intoxication resulting in seizures. In the present case, several differential diagnoses can be considered as potential causes of mental deterioration with non-convulsive status epilepticus. The clinical features of CO poisoning are non-specific, and physicians may consider a broad range of diagnostic possibilities. CO is an odorless, colorless, and nonirritant gas produced by the incomplete combustion of carbon-based fuels. We experienced a patient with CO poisoning with non-convulsive status epilepticus treated with HBO 2. On day 40 after CO poisoning, she was semi-comatose with rare responses to painful stimuli and transferred to a nursing hospital without any recovery (GCS 3). Continuous EEG monitoring showed an absence of epileptiform activity ( Fig. She was diagnosed with non-convulsive status epilepticus and intravenous infusion of 1,000 mg of levetiracetam and 1,500 mg of valproic acid was therefore administered. An electroencephalogram (EEG) was performed and showed continuous and diffuse high amplitude paroxysmal sharp waves at 2–3 Hz ( Fig. Magnetic resonance imaging revealed a diffuse, confluent hyperintensity on T2-weighted sequences in bilateral cerebral white matter, suggesting demyelination of the cerebral white matter ( Fig. On day 28, she was unconscious with a GCS score of 3/15 and her COHb level was 0.9%. ![]() On neurological examination, she was found to be alert and able to communicate normally (GCS 13). ![]() Following HBO 2 therapy, the patient recovered spontaneous respiration and the tube was removed. She underwent three HBO 2 sessions over the course of 3 days. CO poisoning was suspected because of the increased level of COHb (19.3%) and 100% oxygen administration was initiated. Brain magnetic resonance imaging showed bilaterally symmetric focal abnormalities involving the globus pallidi ( Fig. Electrocardiography revealed sinus tachycardia without a change in the ST segment. Other results of blood chemistry was normal. Urine toxicology screening tests gave negative results. No abnormalities were detected in the cerebrospinal fluid except for mildly elevated protein contents of 51 mg/dL. Laboratory tests found a serum prolactin level of 69.19 ng/mL, high sensitivity-C reactive protein (hs-CRP) level of 1.719 mg/dL, and erythrocyte sedimentation rate (ESR) of 15 mm/h. Her arterial blood gas results in room air were as follows: pH 7.48, PaCO 2 32 mmHg, PaO 2 50 mmHg, base excess −2.1 mmol/L, SaO 2 95.2%, and COHb 19.3%. Examination of the vital signs found an oral body temperature of 37☌, a regular pulse of 93 beats/min, blood pressure of 67/45 mmHg, and pulse oximetry of 93% in room air. The pupils were bilaterally equal, 3 mm in size and reactive to light. On arrival at our emergency room, she was unconscious with a Glasgow coma scale (GCS) score of 7/15. She had been treated with risperidone, amitriptyline, and escitalopram for paranoid schizophrenia and bipolar disorder during 10 years. Apart from burning charcoal, she also took an unknown amount of hypnotic drugs. She was found unconscious after 3 hours of exposure to CO from the burning charcoal. A 71-year-old woman attempted suicide by burning charcoal at home. ![]()
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