• The Korean Journal of Nuclear Medicine
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• v.22 no.2
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• pp.163-170
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• 1988

8 patients of delayed CO sequelae were evaluated using Brain CT and $^{99m}Tc-HMPAO$ SPECT. The results were as follows; 1) CT findings of delayed CO sequleae were bilateral low density lesion in globus pallidus (l pt.), diffuse low density in white matter with bilateral low density in white matter (l pt.), diffuse low density in white matter with bilateral low density in globus pallidus (l pt.), diffuse low density in white matter with cortical atrophy (l pt.), bilateral low density in globus pallidus and diffuse low density in white matter with cortical atrophy (l pt.) and normal in 3 pts. 2) $^{99m}Tc-HMPAO$ Brain SPECT findings of delayed CO sequelae were decreased regional cerebral blood flow (rCBF) in frontal (1 among 8 pts.), frontal and basal ganglia (3 among 8 pts.), and diffuse patch decreased rCBF pattern (4 among 8 pts.) 3) $^{99m}Tc-HMPAO$ Brain SPECT study was well correlated with neurologic symptoms and signs in delayed CO sequelae. Our results may suggest that reduced cerebral blood flow contributes to the development of delayed CO sequelae.

• The Journal of Internal Korean Medicine
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• v.43 no.2
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• pp.159-165
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• 2022

Objective: This clinical study describes the effect of Korean medicine on a patient with Delayed Neuropsychiatric Sequelae after Carbon Monoxide Poisoning. Case presentation: A patient with the delayed neuropsychiatric effects of carbon monoxide exposure was treated with herbal medicine, acupuncture, moxibustion, and cupping. Clinical symptoms were measured with the Korean Mini Mental State Examination (K-MMSE), Functional Independence Measure (FIM), and the Modified Barthel Index (MBI). After 32 days of treatment, the patient's K-MMSE score increased from 11 to 21 points, the FIM score from 52 to 94 points, and the MBI score from 46 to 84 points. There were no side effects. Conclusion: According to this case study, Korean medicine may be considered an effective treatment for delayed neuropsychiatric sequelae, although more studies are needed to confirm its validity.

• The Journal of Korean Medicine
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• v.22 no.3
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• pp.169-178
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• 2001

After initial recovery from acute carbon monoxide (CO) intoxication, some patients occasionally undergo severe neuropsychiatric deterioration, which is called postanoxic delayed encephalopathy (sequelae). This is the clinical report about one patient, a 73-year-old man, diagnosed with delayed encephalopathy after acute CO intoxication. The symptoms of the patient were mental dysfunction including memory impairment and disorientation, abnormal behavior, incontinence and mutism. He had completely recovered after an aonxic episode, but the neurological symptoms that developed were preceded by an interval of apparent normality (the 'lucid interval'). We characterized him as suffering deficiency syndrome of the heart and prescribed for him Bokreongbosim-tang and Guipi-tang, and thereafter his symptoms were remarkably improved. For the evaluation of clinical improvement, we use the Modified Barthel Index (MBI), Canadian Neurologic Scale (CNS), and the Korean version of the Mini-Mental State Examination (K-MMSE)

• The Journal of Internal Korean Medicine
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• v.40 no.5
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• pp.957-966
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• 2019

Carbon monoxide intoxication leads to hypoxia, which eventually leads to tissue ischemia. Delayed neuropsychiatric syndrome (DNS) can be a consequence and appears in the form of cognitive impairment and movement disorders after a lucid interval. A 58-year-old Korean male was admitted to our hospital with delayed neuropsychiatric sequelae (DNS) after an 11-day lucid interval following recovery from acute carbon monoxide intoxication. We treated him with herbal medication, acupuncture, electroacupuncture, and moxibustion. The effects were assessed by the activity index and Mini Mental State Examination-Korea (MMSE-K) scores, and by changes in gait disturbance. In this case, the clinical symptoms, including gait disturbance, and the activity index and MMSE-K scores, improved after traditional Korean treatment. The findings of this case report suggest that traditional Korean medicine treatment can be effective for treatment of symptoms of delayed neuropsychiatric sequelae due to CO intoxication.

• Journal of Physiology & Pathology in Korean Medicine
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• v.19 no.1
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• pp.279-283
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• 2005

After initial recovery from acute carbon monoxide(CO) intoxication, some patients occasionally undergo severe neuropsychiatric deterioration, which is called postanomic delayed encephalopathy(sequelae). This is the clinical study about one patient, a 53-year-old woman, diagnosed with delayed encephalopathy after acute CO intoxication. The patient's symptoms were mental dysfunction including memory impairment and disorientation, aphasia, atrophy and weakness throughtout the body. She had completely recovered after an anomic episode, but the neurological symptoms that developed were preceded by an interval of apparent nomality.(the 'lucid interval'). She was characterized as suffering deficiency syndrome of the heart(心虛) and was prescribed for her an Ansinschungnoi-tang(安神淸腦湯), and thereafter her symptoms improved remarkably. For the evaluation of clinical improvement, we use the Modified Barthel Index(MBI).

• Journal of The Korean Society of Clinical Toxicology
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• v.9 no.2
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• pp.88-94
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• 2011

Purpose: Delayed neuropsychological sequelae (DNS) commonly occurs after recovery from acute carbon monoxide poisoning. The aim of this article is to identify the factors associated with DNS development. Methods: We retrospectively evaluated patients, admitted to the medical center emergency department from June 2005 to March 2011, who were suffering from acute carbon monoxide (CO) poisoning. We categorized the patients into two groups - those with DNS, and those without DNS. Multiple regression analysis was performed to identify the factors related to manifestation of DNS. Results: Of the total one hundred fifty seven patients (157) recruited for the study, twenty two (22) developed DNS. Longer CO exposure times and lower GCS scores were positively associated with development of DNS symptoms. Conclusion: Our study identified two potential factors which are predictive of DNS development in CO intoxication, however, more studies are needed. Adequate follow-up after hospital discharge to monitor for and accurately identify manifestation of DNS, is also important.

• Journal of The Korean Society of Clinical Toxicology
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• v.16 no.2
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• pp.102-107
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• 2018

Purpose: This study examined the association between smoking and delayed neuropsychological sequelae (DNS) in acute carbon monoxide (CO) poisoning. Methods: Patients admitted to the medical center emergency department from March 2016 to March 2017 because of CO poisoning were examined retrospectively. The patients were divided into two groups: DNS and Non-DNS group. Multiple factors were analyzed to explain DNS, which was assessed by motor disturbances, cognitive impairment, dysphagia, Parkinson-like syndromes, epilepsy, and emotional lability in CO poisoning. Results: A total of 120 patients were included. The factors related to DNS were smoking (pack-years) (p=0.002) and initial carbon monoxide-hemoglobin level (p=0.015). On the other hand, after multivariate logistic regression analysis, smoking (Odds ratio 1.07; 95% CI, 1.02-1.13; p=0.004) was the only factor associated with DNS. Conclusion: Smoking is a very reliable factor for predicting the occurrence of DNS. A history of smoking in patients who suffer from CO intoxication is important. If a patient smokes, treatment should be started actively and as soon as possible.

• Journal of The Korean Society of Emergency Medicine
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• v.29 no.5
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• pp.519-528
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• 2018

Objective: Delayed neuropsychiatric sequelae (DNS) following carbon monoxide (CO) poisoning, which may result from a demyelinating leukoencephalopathy, is a disease with a poor prognosis. This study examined the factors affecting the long-term prognosis of DNS and the efficacy of hyperbaric oxygen therapy (HBOT) in patients with DNS. Methods: This retrospective study included 84 patients with DNS following CO poisoning from January 2013 to June 2016. HBOT was given to 24 patients. The patients were divided into an improvement group and non-improvement group based on their clinical condition on a telephone interview at intervals between 3 months and 3 years after the onset of DNS. The improvement group was defined as having Cerebral Performance Category (CPC) scores in their daily life that improve to 1 or 2 grade. Results: Of the 594 patients, DNS were found in 18.2%, and 70.2% (59 of 84) of the patients with DNS improved. The prognostic factors for the improvement of DNS were an age of 45 years or less (odds ratio [OR], 12.068; 95% confidence interval [CI], 2.393-60.858; P<0.005), CPC score of 1 or 2 group at the time of DNS onset (OR, 12.361; 95% CI, 3.161-48.330; P<0.005), and a lucid interval longer than 20 days (OR, 5.164; 95% CI, 1.393-19.141; P<0.01). HBOT was not associated with the improvement of DNS in CO poisoning (OR, 0.467; 95% CI, 0.172-1.269; P>0.1). Conclusion: Patients aged less than 45 years, low grade CPC score of 1 and 2, and lucid interval longer than 20 days are more likely to have a good prognosis. On the other hand, HBOT failed to produce a benefit for DNS patients.

• Annals of Clinical Neurophysiology
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• v.15 no.2
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• pp.63-67
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• 2013

Multiple cranial and peripheral neuropathies as a delayed sequellae of ethylene glycol poisoning is a less well known clinical entity and its information about long-term electrophysiological and clinical outcomes is limited. We report a 45-year-old male who presented with acute renal failure and subsequently developed multiple cranial neuropathy, respiratory failure, and flaccid tetraparesis. Through sequential electrophysiological studies, we would like suggest that the main pathophysiology of ethylene glycol-related neuropathy is a demyelinating polyradiculoneuropathy with secondary axonal degeneration.

• The Journal of Korean Medicine
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• v.39 no.3
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• pp.73-80
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• 2018

Carbon monoxide poisoning leads to hypoxia, which eventually leads to tissue ischemia. The delayed neuropsychiatric syndrome can arise in the period from 4 days to 5 weeks following carbon monoxide poisoning. This case report describes a male who suffered from delayed sequelae after self-inflicted carbon monoxide poisoning. At the time of admission, he had symptoms of quadriplegia, both upper limb ankylosis, gait disturbance, and dysuria. He was treated with acupuncture, electro-acupuncture, physical therapy, and Uwhangchungsim-won. Paraplegia improved considerably after 7 days in hospital, and paralysis of the both upper extremities improved after 14 days in hospital. He was able to walk holding on to his wheelchair after 28 days in hospital. He was hospitalized for 55 days and was discharged from the hospital in a fine condition for everyday life. This case report suggests the possibility that korean medicine for delayed neuropsychiatric syndrome.