Delayed encephalopathy and cognitive sequelae after acute carbon monoxide poisoning: report of a case and review of the literature.

J Med Assoc Thai. 2009 Oct;92(10):1374-9.


Division of Neurology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.


Serious delayed encephalopathy and cognitive sequelae following acute carbon monoxide intoxication constitutes a rare and a distinct entity. A case of delayed encephalopathy and cognitive sequelae after acute carbon monoxide poisoning is presented. The patient is a 50-year-old Thai female with a history of carbon monoxide poisoning during her vacation tour in Arizona in winter. She developed encephalopathy 4 weeks after recovery from the acute stage. Her MRI-brain found abnormal white matter change of cerebral hemispheres bilaterally and abnormal signal intensity at both putamens and caudate nuclei. She regained some improvement in her memory and other cognitive function after 4 weeks of treatment including hyperbaric oxygen therapy (HBOT).


[Carbon monoxide poisoning; psychotic depression brought on by a new kitchen].

Tijdschr Psychiatr. 2008;50(4):235-9.

[Article in Dutch]


Bavo-Europoort, divisie Ouderen, K.P. van de Mandelelaan 120, 3062 MB Rotterdam.


BACKGROUND: An 81-year-old woman was diagnosed with chronic carbon monoxide poisoning. Her symptoms closely resembled those of someone with depression, although some of her symptoms were atypical. Because carbon monoxide is a colourless, odourless gas, the cause of her condition remained unclear for several weeks. If psychiatrists are better informed about the affective and neuropsychological symptoms that frequently accompany carbon monoxide poisoning, they should be able to recognise the symptoms sooner. This in turn should lead to a better outcome for the patient.

[Case report: kleptomania and other psychiatric symptoms after carbon monoxide intoxication].

Turk Psikiyatri Derg. 2007 Spring;18(1):80-6.
[Article in Turkish]


Psikiyatri AD., Celal Bayar U Tip Fak., Manisa, Turkey.


Carbon monoxide (CO) intoxication is usually a serious condition, which can result in neurological disturbances or death. In some patients with CO intoxication, but not usually, a biphasic pattern can be seen. In this condition, after antitoxic treatment, patients may completely recover and after a short recovery period, neurological and/or psychiatric symptoms appear again. This condition is known as delayed encephalopathy and its occurrence rate is between 0.06% and 11.8%. Herein, we report a case with delayed encephalopathy after CO intoxication, which began with neurological symptoms and continued with obsessive-compulsive disorder, depression, kleptomania, and psychotic disorder. The 41-year-old female patient had no psychiatric or neurological symptoms or disorders prior to CO intoxication. Increased signal intensity changes in the basal region of the left temporal lobe (including the cortex and subcortical white matter), globus pallidus (bilateral), and cerebellar cortical and subcortical white matter (bilaterally symmetrical) was detected on axial T2-weighted magnetic resonance imaging (MRI). In addition, there were atrophic changes in both cerebellar hemispheres. To the best of our knowledge, this is the first case of kleptomania described after CO intoxication in the literature. We discuss the organic etiology of kleptomania and the other psychiatric symptoms of this patient in the light of recent research. We concluded that the kleptomania seen in this patient was related to concurrent lesions in the temporal lobe and globus pallidus; in other words, her kleptomania may have been related to dysfunction simultaneously seen in both the temporolimbic and frontal-subcortical circuits.

[PubMed – indexed for MEDLINE]

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