Clinical and Magnetic Resonance Imaging Findings of Patients with Acute Carbon Monoxide Poisoning

Year 2020, , 443 - 450, 20.10.2020

Nezih Kavak , Burcu Doğan Hasan Sultanoğlu , Rasime Pelin Kavak , Meltem Özdemir

https://doi.org/10.18521/ktd.735274

Abstract

Objective: We aim to evaluate the demographic and clinical characteristics of patients with acute carbon monoxide (CO) poisoning, who had a Glasgow Coma Score (GCS) below 15, and who had cerebral lesions detected in magnetic resonance imaging (MRI).

Method: The age, gender, causes of CO intoxication, clinical signs, neurological findings, GCS, blood carboxyhemoglobin level (COHb), serum pH, lactate, creatine kinase (CK), creatinine kinase-myocardial band MB (CK-MB), troponin-I level, brain MRI findings, treatment, and mortality status of 327 patients were evaluated retrospectively.

Results: The median age of patients was 31.5 years (IQR=19.5 years), 72.2% of the patients were women. Neurological findings were detected in 34 (10.4%) of the patients. The frequency of dyspnea was significantly higher in patients with neurological findings (p<0.05). The COHb and lactate levels of patients with neurological findings were found to be significantly high, the pH level was significantly lower (p<0.05). There was no significant relationship between the presence of neurological findings and CK, CK-MB, and troponin-I levels (p>0.05). Patients with neurological findings were found to have a significantly longer follow-up period,
more frequently received hyperbaric oxygen therapy (p<0.05). The rate of hospitalization was 10.7%, the mortality rate was 0.9%. Hospitalization and mortality rates were significantly high in patients with neurological findings (p <0.05). Pathological findings were detected in 13 (40.6%) of 32 of patients who had an MRI.

Conclusion: It was determined that acute CO poisoning may lead to acute brain damage, 40% would be detected in brain MRIs taken in patients during the acute phase.

Keywords

Carboxyhemoglobin, Emergency department, Magnetic resonance imaging, Mortality

Akut Karbonmonoksit Zehirlenmesi olan Hastalarının Klinik ve Manyetik Rezonans Görüntüleme Bulguları

Abstract

Amaç: Bu çalışmada akut karbon monoksit (CO) zehirlenmesi tanısı konulan hastaların demografik ve klinik özellikleri ile Glasgow Koma Skoru (GKS) 15’in altında olan hastaların manyetik rezonans görüntüleme (MRG)’de tespit edilen serebral lezyonları tanımlamayı amaçladık.

Yöntem: 327 hasta yaş, cinsiyet, CO zehirlenme nedenleri, klinik belirtileri, nörolojik bulguları, GKS’ları, karboksihemoglobin (COHb), serum pH, laktat, kreatin kinaz (CK), kreatini kinaz, miyokardiyal band (CK-MB), troponin-I düzeyleri ile beyin MRG bulguları ve mortalite durumları açısından retrospektif olarak değerlendirildi.

Bulgular: Çalışmamızda hastaların yaş ortancası 31.5 yıl (IQR=19.5 yıl) olup, hastaların %72.2’si kadındı. Hastaların 34 (%10.4)’ünde nörolojik bulgular saptandı Nörolojik bulgusu olan hastaların dispne sıklığı anlamlı olarak yüksekti (p<0,05). Çalışmamızda nörolojik bulgusu olan hastaların COHb düzeyi ve laktat düzeyi anlamlı olarak yüksek, pH düzeyi anlamlı olarak düşük saptandı (p<0,05). Nörolojik bulgu varlığının CK, CK-MB ve troponin-I düzeyi arasında anlamlı bir ilişki saptanmadı (p>0,05). Nörolojik bulgusu olan hastaların, takip süresi anlamlı olarak uzun olduğu, daha sıklıkla hiperbarik oksijen tedavisi aldığı saptandı (p<0,05). Çalışmamızda olguların yatış oranı % 10.7, mortalite oranı % 0,9 olarak saptandı. Nörolojik bulgusu olan hastalarda yatış ve mortalite oranları anlamlı olarak yüksek saptandı (p<0,05). MRG çekilen 32 olgunun 13’ünde (%40.6) patolojik bulgulara rastlandı.

Sonuç: Akut karbonmonoksit zehirlenmelerinin akut beyin hasarına yol açabileceği, klinik bulgu veren bu hastalarda akut dönemde çekilen MRG’sinde %40 oranında bulgu vereceği saptandı.

Keywords

Karboksihemoglobin, Acil servis, Manyetik rezonans görüntüleme, Mortalite

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