Cortical White-matter Lesions as Initial Radiologic Finding in Carbon Monoxide Intoxication: A Case Report

Abstract

Aims: Present a case of carbon monoxide (CO)-intoxication with initial presence of cortical lesions instead of globus pallidus lesions, to create awareness of atypical or late MRI findings in patients with CO-intoxication. Presentation of the Case: A 27 year old women with no medical history presents with a reduced level of consciousness due to CO-intoxication. After a lucid interval of two to three days, patient develops altered behavior, headache and loss of short term memory. This symptoms worsen and seven days after discharge she is readmitted to the hospital. MRI of the cerebrum shows cortical hypoxic lesions, but no abnormalities in the basal ganglia. There is only little clinical improvement in the following weeks. Repeated MRI on day 20 shows newly developed lesions in the globus pallidus, pathognomic for CO-intoxication. Discussion and Conclusion: This case demonstrates how radiologic lesions can develop until weeks after the clinical presentation in patients with CO-intoxication, and that cortical lesions can develop in the absence of globus pallidus lesions. CO-induced cerebral lesions can be explained by several complex mechanisms, not only by hypoxia.