Factors affecting the prognosis of patients with delayed encephalopathy after acute carbon monoxide poisoning

Hyperbaric oxygen therapy (HBOT) remains controversial. But there is increasing evidence that its use early in more severe cases of poisoning can reduce the incidence of long-term problems, in particular the delayed neuropsychiatric syndrome.

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Chronic low level exposure and cognitive impairment

Low level exposure to CO shown to cause cognitive impairment in student volunteers.

CO makes you dizzy..

An 'unusual' case of dizziness reported in the Journal of Laryngology and Otology.

Delayed neurological symptoms are immune-mediated

This paper by Stephen Thom in the Proceedings of the National Academy of Sciences of the USA postulates an immune-mediated mechanism for the phenomenon of delayed neuropsychiatric sequelae following non-fatal CO exposure.

DNS is not a new phenomenon

The delayed neuropsychiatric syndrome associated with CO exposure is in no way a newly-discovered phenomenon, as this paper from JAMA of 1912 illustrates.

Delayed Neuro problems - a Korean case

An interesting recent case report from Korea illustrating a case of delayed neuropsychiatric sequelae.
South Korea has one of the highest incidences of domestic, unintentional CO poisoning in the world, with a death rate about ten times that in the UK. This is thought to be thanks to the traditional heating methods in some Korean homes, which is to leave a large lump of charcoal smouldering underneath the house overnight.

'Delayed postanoxic encepalopathy'

Another name for 'DNS', or Delayed Neuropsychiatric Sequelae.
A case report from the Emergency Medicine Journal (http://emj.bmj.com/cgi/content/full/21/2/250).

pdf copy available by clicking here.

CO messes with your head - it's official.

It's quite well known that students are at high risk of CO exposure. What is less well known is that they are sometimes put deliberately at risk by their professors!
This valuable piece of research (Archives of Neurology 1998; 55 (6), 845) shows just how damaging low-level CO exposure is to the CNS. But I'm not sure it should have received ethical approval!

By going to this link to my public folder on box.net you can retrieve a pdf copy of this paper.

Optic and other neuritides

CO is especially toxic to the central and peripheral nervous systems.
Optis neuritis is a recognised sequela of exposure, as is peripheral neuritis (sometimes picking out a single peripheral nerve such as femoral, sciatic, ulnar) and various other patterns of mixed neuronal damage.

Delayed Neuropsychiatric Syndrome (DNS)

Someone poisoned by CO may seem to make a full recovery, only to relapse perhaps several days later with any of a whole gamut of neurological and psychiatric symptoms. These may even be enough to mimic a full-blown organic psychosis.
This link is to a BMJ editorial mentioning this phenomenon.

Stephen Thom has published extensively over many years about the effects of CO, and this article in the Proceedings of the National Academy of Sciences covers DNS in detail. It has 38 references, many accessible on line.

For more coverage of this phenomenon, try this pdf file (you will need Adobe Acrobat Reader) from the World Health Organisation.