technetium-tc-99m-bicisate and Carbon-Monoxide-Poisoning

99mTc ethyl cysteinate dimer (99mTc-ECD) brain single photon emission computed tomography (SPECT) was used to detect abnormal regional cerebral blood flow (rCBF) in patients with acute carbon monoxide (CO) poisoning. Ten patients with acute CO poisoning and no past histories of psychoneurological disorders were enrolled in this study. After oxygen treatment, all of the 10 patients were investigated using 99mTc-ECD brain SPECT and brain computed tomography (CT) scan. Brain CT scan findings were normal in all of the 10 patients. 99mTc-ECD brain SPECT showed the hypoperfusion lesions of the basal ganglia and brain cortex in five and seven patients, respectively. Only three of the 10 patients had normal 99mTc-ECD brain SPECT findings. This study suggests that, in comparison with brain CT scan, 99mTc-ECD brain SPECT is a better tool for the early detection of hypoperfusion brain lesions in acute CO poisoning in patients with normal brain CT findings.

Topics: Adolescent; Adult; Brain; Brain Ischemia; Carbon Monoxide Poisoning; Cerebrovascular Circulation; Cerebrovascular Disorders; Cysteine; Female; Humans; Male; Organotechnetium Compounds; Radiography; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Tomography, Emission-Computed, Single-Photon

This study aimed to characterize changes in regional cerebral blood flow (rCBF) in patients who experienced carbon monoxide (CO) poisoning and subsequently developed severe delayed neuropsychiatric sequelae (DNS) with akinetic mutism. We determined whether these changes were reversible in parallel with improvements in neuropsychological function in response to treatment, including hyperbaric oxygen therapy.. Patients who developed severe DNS with akinetic mutism after acute CO intoxication between 2007 and 2011 were enrolled. Tc-ECD brain SPECT findings were compared between the patients with severe akinetic mutism and age-matched control subjects to characterize the pattern of rCBF. Perfusion SPECT was correlated with clinical outcomes after treatment with statistical parametric mapping (SPM8); the height threshold was P < 0.01 at peak level, and the corrected false discovery rate was P < 0.05 at the cluster level.. Seven patients with akinetic mutism were analyzed. All patients had neurological symptoms caused by acute CO exposure, and all recovered to nearly normal daily function after initial treatments. In all cases, after a "lucid interval," DNS progressed to akinetic mutism. The SPECT images acquired at the onset of akinetic mutism demonstrated variable hypoperfusion in frontal-temporal-parietal regions, with the greatest severity in the left temporal-parietal regions. In parallel, we performed functional neuropsychiatric tests. After treatment, the brain SPECT showed significantly fewer hypoperfusion regions, and neuropsychiatric tests showed dramatically improved function.. Our findings demonstrated both cerebral cortical and subcortical injuries in patients with CO-induced akinetic mutism. Improvement in rCBF correlated well with functional recovery after treatment.

Topics: Adult; Aged; Akinetic Mutism; Carbon Monoxide Poisoning; Cerebrovascular Circulation; Cysteine; Female; Humans; Male; Middle Aged; Organotechnetium Compounds; Perfusion Imaging; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon

We herein report the case of a 65-year-old woman who presented with the subacute onset of dementia and subsequently developed abnormal behavior and a gait disturbance. Her condition transiently improved; however, within one month, she became drowsy and poorly responsive, with limb chorea and urinary incontinence. Her history of frequently using charcoal led us to diagnose her with carbon monoxide (CO) poisoning. The findings of this case and a literature review suggest that subacute dementia due to CO poisoning recovers late, after a year or more, in patients above sixty years of age, and both hyperbaric oxygen and corticosteroid pulse therapy should be considered in such cases, even after one month.

Topics: Adrenal Cortex Hormones; Aged; Brain; Carbon Monoxide Poisoning; Cysteine; Dementia; Female; Gait; Humans; Hyperbaric Oxygenation; Leukoencephalopathies; Magnetic Resonance Imaging; Movement Disorders; Organotechnetium Compounds; Radiopharmaceuticals; Time Factors; Tomography, Emission-Computed, Single-Photon

While lesion patterns in white matter have been extensively reported in the literature on carbon monoxide (CO) intoxication, reports on the effects on gray matter damage are less common. The aim of this study was to investigate regional damage patterns focusing on gray matter using (99m)Tc ethyl cysteinate dimer (ECD) brain single photon emission computed tomography (SPECT) and brain magnetic resonance imaging (MRI) with clinical correlation.. Thirty CO intoxication patients and 15 age-matched controls were enrolled for standard neuropsychological tests. Six regions of interest (ROI) were analyzed qualitatively and quantitatively in both SPECT and MRI. The patients were further grouped according to clinical dementia rating score. The sensitivity, specificity, and positive and negative predictive ratios related to dementia from both imaging modalities were further examined.. In SPECT qualitative analysis, basal ganglia (n = 16) were the most common regions showing lower perfusion patterns. The basal ganglion and temporal, frontal, and parietal regions of the patients with dementia showed significantly lower perfusion patterns. MRI had a higher sensitivity while SPECT had a higher specificity and positive and negative predictive ratios in correlation with dementia among the ROI. The perfusion indices of the frontal, temporal, basal ganglion, and thalamus were inversely correlated with clinical severity (all P < 0.05).. Our findings suggest that a multiparametric neuroimaging approach may provide more information in revealing the anatomical and neurobehavioral results in patients after CO intoxication. The atrophy pattern seen in MRI may explain in part the possible mechanism of the hypoperfusion state seen in SPECT.

Topics: Adult; Brain; Carbon Monoxide Poisoning; Cerebrovascular Circulation; Cognition; Cysteine; Dementia; Female; Humans; Magnetic Resonance Imaging; Male; Neuropsychological Tests; Organotechnetium Compounds; Predictive Value of Tests; Tomography, Emission-Computed, Single-Photon