NEW YORK (Reuters Health) – Acute brain lesions on MRI are associated with an increased risk of delayed neurological sequelae after carbon monoxide (CO) poisoning, researchers from Korea report.
Neurological symptoms of CO poisoning can appear as late as 6 weeks after successful resuscitation. Diffusion-weighted imaging (DWI) can identify acute brain lesions in CO poisoning, but it remains unclear how these might be related to the development of delayed neurological sequelae .
Dr. Won Young Kim and colleagues from University of Ulsan College of Medicine, Seoul, South Korea, investigated the prevalence and characteristics of such acute brain lesions on DWI and whether their presence is related to the development of delayed neurological sequelae in 387 patients with acute CO poisoning. Their findings were reported online January 29 in JAMA Neurology.
Just over a quarter of patients (26.9%) had acute brain lesions on DWI, most commonly in the globus pallidus. Delayed neurological sequelae followed CO poisoning in 26.1% of patients.
Although the pattern, region, and location of acute brain lesions on DWI did not differ between patients who developed delayed sequelae and those who did not, their presence was independently associated with nearly a 14-fold increased risk of delayed neurological sequelae.
The presence of acute brain lesions on DWI had 75.2% sensitivity and 90.2% specificity for predicting delayed neurological sequelae, with a positive predictive value of 73.1% and a negative predictive value of 91.2%.
Other factors independently associated with the development of delayed neurological sequelae included altered mental status and longer duration of CO exposure.
“Diffusion-weighted imaging during the acute phase of CO poisoning may therefore help identify patients at risk of developing these debilitating sequelae,” the researchers conclude. “Further studies are needed to validate our findings.”
Dr. Marco Varrassi from S. Salvatore Hospital, L’Aquila, Italy, who recently reviewed the neuroimaging of CO poisoning, told Reuters Health by email, “MRI should always be performed in the acute phase, because it provides an excellent tool to predict the long-term prognosis of these patients.”
He said that it is also essential to follow these patients “for quite a long time even if clinical conditions are good at discharge.”
Dr. Varrassi added, “It would be very important to find a correlation, if it exists, between therapeutic strategy in the acute phase and future development of delayed neurological sequelae, since this condition can be very debilitating.”
Dr. Kim did not respond to a request for comment.
SOURCE: http://bit.ly/2DUKph9
JAMA Neurol 2018.
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