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BMC Neurology
Published in: BMC Neurology 1/2013

Open Access 01-12-2013 | Research article

Structural and cognitive deficits in chronic carbon monoxide intoxication: a voxel-based morphometry study

Authors: Hsiu-Ling Chen, Pei-Chin Chen, Cheng-Hsien Lu, Nai-Wen Hsu, Kun-Hsien Chou, Ching-Po Lin, Re-Wen Wu, Shau-Hsuan Li, Yu-Fan Cheng, Wei-Che Lin

Published in: BMC Neurology | Issue 1/2013

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Abstract

Background

Patients with carbon monoxide (CO) intoxication may develop ongoing neurological and psychiatric symptoms that ebb and flow, a condition often called delayed encephalopathy (DE). The association between morphologic changes in the brain and neuropsychological deficits in DE is poorly understood.

Methods

Magnetic resonance imaging and neuropsychological tests were conducted on 11 CO patients with DE, 11 patients without DE, and 15 age-, sex-, and education-matched healthy subjects. Differences in gray matter volume (GMV) between the subgroups were assessed and further correlated with diminished cognitive functioning.

Results

As a group, the patients had lower regional GMV compared to controls in the following regions: basal ganglia, left claustrum, right amygdala, left hippocampus, parietal lobes, and left frontal lobe. The reduced GMV in the bilateral basal ganglia, left post-central gyrus, and left hippocampus correlated with decreased perceptual organization and processing speed function. Those CO patients characterized by DE patients had a lower GMV in the left anterior cingulate and right amygdala, as well as lower levels of cognitive function, than the non-DE patients.

Conclusions

Patients with CO intoxication in the chronic stage showed a worse cognitive and morphologic outcome, especially those with DE. This study provides additional evidence of gray matter structural abnormalities in the pathophysiology of DE in chronic CO intoxicated patients.
Appendix
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Literature
1.
Ernst A, Zibrak JD: Carbon monoxide poisoning. N Engl J Med. 1998, 339 (22): 1603-1608. 10.1056/NEJM199811263392206.CrossRefPubMed
2.
Winter PM, Miller JN: Carbon monoxide poisoning. JAMA: J Am Med Assoc. 1976, 236 (13): 1502-1504. 10.1001/jama.1976.03270140054029.CrossRef
3.
Sohn YH, Jeong Y, Kim HS, Im JH, Kim JS: The brain lesion responsible for parkinsonism after carbon monoxide poisoning. Arch Neurol. 2000, 57 (8): 1214-1218. 10.1001/archneur.57.8.1214.CrossRefPubMed
4.
Kwon OY, Chung SP, Ha YR, Yoo IS, Kim SW: Delayed postanoxic encephalopathy after carbon monoxide poisoning. Emerg Med J. 2004, 21 (2): 250-251. 10.1136/emj.2002.002014.CrossRefPubMedPubMedCentral
5.
Choi IS, Kim SK, Choi YC, Lee SS, Lee MS: Evaluation of outcome after acute carbon monoxide poisoning by brain CT. J Korean Med Sci. 1993, 8 (1): 78-83.CrossRefPubMedPubMedCentral
6.
Jones JS, Lagasse J, Zimmerman G: Computed tomographic findings after acute carbon monoxide poisoning. Am J Emerg Med. 1994, 12 (4): 448-451. 10.1016/0735-6757(94)90059-0.CrossRefPubMed
7.
Myers RA, Britten JS: Are arterial blood gases of value in treatment decisions for carbon monoxide poisoning?. Crit Care Med. 1989, 17 (2): 139-142. 10.1097/00003246-198902000-00007.CrossRefPubMed
8.
Kim JH, Chang KH, Song IC, Kim KH, Kwon BJ, Kim HC, Han MH: Delayed encephalopathy of acute carbon monoxide intoxication: diffusivity of cerebral white matter lesions. AJNR Am J Neuroradiol. 2003, 24 (8): 1592-1597.PubMed
9.
Chang KH, Han MH, Kim HS, Wie BA, Han MC: Delayed encephalopathy after acute carbon monoxide intoxication: MR imaging features and distribution of cerebral white matter lesions. Radiology. 1992, 184 (1): 117-122.CrossRefPubMed
10.
Lin WC, Lu CH, Lee YC, Wang HC, Lui CC, Cheng YF, Chang HW, Shih YT, Lin CP: White matter damage in carbon monoxide intoxication assessed in vivo using diffusion tensor MR imaging. AJNR Am J Neuroradiol. 2009, 30 (6): 1248-1255. 10.3174/ajnr.A1517.CrossRefPubMed
11.
Chen NC, Chang WN, Lui CC, Huang SH, Lee CC, Huang CW, Chuang YC, Chang CC: Detection of gray matter damage using brain MRI and SPECT in carbon monoxide intoxication: a comparison study with neuropsychological correlation. Clin Nucl Med. 2013, 38 (2): e53-59. 10.1097/RLU.0b013e31827082a7.CrossRefPubMed
12.
Kesler SR, Hopkins RO, Blatter DD, Edge-Booth H, Bigler ED: Verbal memory deficits associated with fornix atrophy in carbon monoxide poisoning. J Int Neuropsychol Soc. 2001, 7 (5): 640-646. 10.1017/S1355617701005112.CrossRefPubMed
13.
Porter SS, Hopkins RO, Weaver LK, Bigler ED, Blatter DD: Corpus callosum atrophy and neuropsychological outcome following carbon monoxide poisoning. Arch Clin Neuropsychol. 2002, 17 (2): 195-204.CrossRefPubMed
14.
Gale SD, Hopkins RO, Weaver LK, Bigler ED, Booth EJ, Blatter DD: MRI, quantitative MRI, SPECT, and neuropsychological findings following carbon monoxide poisoning. Brain Inj. 1999, 13 (4): 229-243. 10.1080/026990599121601.CrossRefPubMed
15.
Cheng Y, Chou KH, Decety J, Chen IY, Hung D, Tzeng OJ, Lin CP: Sex differences in the neuroanatomy of human mirror-neuron system: a voxel-based morphometric investigation. Neuroscience. 2009, 158 (2): 713-720. 10.1016/j.neuroscience.2008.10.026.CrossRefPubMed
16.
Zamboni G, Huey ED, Krueger F, Nichelli PF, Grafman J: Apathy and disinhibition in frontotemporal dementia: insights into their neural correlates. Neurology. 2008, 71 (10): 736-742. 10.1212/01.wnl.0000324920.96835.95.CrossRefPubMedPubMedCentral
17.
Chen NC, Huang CW, Lui CC, Lee CC, Chang WN, Huang SH, Chen C, Chang CC: Diffusion-weighted imaging improves prediction in cognitive outcome and clinical phases in patients with carbon monoxide intoxication. Neuroradiology. 2013, 55 (1): 107-115. 10.1007/s00234-012-1102-0.CrossRefPubMed
18.
Chang CC, Chang WN, Lui CC, Wang JJ, Chen CF, Lee YC, Chen SS, Lin YT, Huang CW, Chen C: Longitudinal study of carbon monoxide intoxication by diffusion tensor imaging with neuropsychiatric correlation. J Psychiatry Neurosci : JPN. 2010, 35 (2): 115-125. 10.1503/jpn.090057.CrossRefPubMedPubMedCentral
19.
Heaton RK: Wisconsin Card Sorting Test manual. Rev. and expanded. edition. 1993, Odessa, Fla. (P.O. Box 998, Odessa 33556): Psychological Assessment Resources
20.
Shan IK, Chen YS, Lee YC, Su TP: Adult normative data of the Wisconsin card sorting test in Taiwan. J Chin Med Assoc. 2008, 71 (10): 517-522. 10.1016/S1726-4901(08)70160-6.CrossRefPubMed
21.
Hsin-Yi Chen M-SH, Jianjun Z, Yung-Hwa c: Selection of factor-based WAIS-III tetrads in the Taiwan standardization sample: a guide to clinical practice. Chinese J Psychol. 2008, 50 (1): 91-109.
22.
Kao YC, Liu YP, Lien YJ, Lin SJ, Lu CW, Wang TS, Loh CH: The influence of sex on cognitive insight and neurocognitive functioning in schizophrenia. Prog Neuropsychopharmacol Biol. 2013, 44: 193-200.CrossRef
23.
Tulsky DS, Price LR: The joint WAIS-III and WMS-III factor structure: development and cross-validation of a six-factor model of cognitive functioning. Psychol Assess. 2003, 15 (2): 149-162.CrossRefPubMed
24.
Ashburner J, Andersson JL, Friston KJ: Image registration using a symmetric prior–in three dimensions. Hum Brain Mapp. 2000, 9 (4): 212-225. 10.1002/(SICI)1097-0193(200004)9:4<212::AID-HBM3>3.0.CO;2-#.CrossRefPubMed
25.
Ashburner J: A fast diffeomorphic image registration algorithm. Neuroimage. 2007, 38 (1): 95-113. 10.1016/j.neuroimage.2007.07.007.CrossRefPubMed
26.
Blumenthal JD, Zijdenbos A, Molloy E, Giedd JN: Motion artifact in magnetic resonance imaging: implications for automated analysis. Neuroimage. 2002, 16 (1): 89-92. 10.1006/nimg.2002.1076.CrossRefPubMed
27.
Ashburner J, Friston KJ: Unified segmentation. Neuroimage. 2005, 26 (3): 839-851. 10.1016/j.neuroimage.2005.02.018.CrossRefPubMed
28.
Cuadra MB, Cammoun L, Butz T, Cuisenaire O, Thiran JP: Comparison and validation of tissue modelization and statistical classification methods in T1-weighted MR brain images. IEEE Trans Med Imaging. 2005, 24 (12): 1548-1565.CrossRefPubMed
29.
Yassa MA, Stark CE: A quantitative evaluation of cross-participant registration techniques for MRI studies of the medial temporal lobe. Neuroimage. 2009, 44 (2): 319-327. 10.1016/j.neuroimage.2008.09.016.CrossRefPubMed
30.
Bergouignan L, Chupin M, Czechowska Y, Kinkingnehun S, Lemogne C, Le Bastard G, Lepage M, Garnero L, Colliot O, Fossati P: Can voxel based morphometry, manual segmentation and automated segmentation equally detect hippocampal volume differences in acute depression?. Neuroimage. 2009, 45 (1): 29-37. 10.1016/j.neuroimage.2008.11.006.CrossRefPubMed
31.
Hayasaka S, Phan KL, Liberzon I, Worsley KJ, Nichols TE: Nonstationary cluster-size inference with random field and permutation methods. Neuroimage. 2004, 22 (2): 676-687. 10.1016/j.neuroimage.2004.01.041.CrossRefPubMed
32.
Lin WC, Chou KH, Chen HL, Huang CC, Lu CH, Li SH, Wang YL, Cheng YF, Lin CP, Chen CC: Structural deficits in the emotion circuit and cerebellum are associated with depression, anxiety and cognitive dysfunction in methadone maintenance patients: a voxel-based morphometric study. Psychiatry Res. 2012, 201 (2): 89-97. 10.1016/j.pscychresns.2011.05.009.CrossRefPubMed
33.
Talairach J, Tournoux P: Co-planar stereotaxic atlas of the human brain : 3-dimensional proportional system: an approach to cerebral imaging. 1988, Stuttgart; New York: Georg Thieme
34.
Li CT, Lin CP, Chou KH, Chen IY, Hsieh JC, Wu CL, Lin WC, Su TP: Structural and cognitive deficits in remitting and non-remitting recurrent depression: a voxel-based morphometric study. Neuroimage. 2010, 50 (1): 347-356. 10.1016/j.neuroimage.2009.11.021.CrossRefPubMed
35.
Glascher J, Tranel D, Paul LK, Rudrauf D, Rorden C, Hornaday A, Grabowski T, Damasio H, Adolphs R: Lesion mapping of cognitive abilities linked to intelligence. Neuron. 2009, 61 (5): 681-691. 10.1016/j.neuron.2009.01.026.CrossRefPubMedPubMedCentral
36.
Gale SD, Hopkins RO: Effects of hypoxia on the brain: neuroimaging and neuropsychological findings following carbon monoxide poisoning and obstructive sleep apnea. J Int Neuropsychol Soc. 2004, 10 (1): 60-71.CrossRefPubMed
37.
Cocito L, Biagioli M, Fontana P, Inglese ML, Pizzorno M, Spigno F, Volpe S: Cognitive recovery after delayed carbon monoxide encephalopathy. Clin Neurol Neurosurg. 2005, 107 (4): 347-350. 10.1016/j.clineuro.2004.09.008.CrossRefPubMed
38.
Hopkins RO, Woon FL: Neuroimaging, cognitive, and neurobehavioral outcomes following carbon monoxide poisoning. Behav Cogn Neurosci Rev. 2006, 5 (3): 141-155. 10.1177/1534582306289730.CrossRefPubMed
39.
Chance B, Erecinska M, Wagner M: Mitochondrial responses to carbon monoxide toxicity. Ann N Y Acad Sci. 1970, 174 (1): 193-204.CrossRefPubMed
40.
Ginsberg MD: Carbon monoxide intoxication: clinical features, neuropathology and mechanisms of injury. J Toxicol Clin Toxicol. 1985, 23 (4–6): 281-288.CrossRefPubMed
41.
Penney DG: Acute carbon monoxide poisoning: animal models: a review. Toxicology. 1990, 62 (2): 123-160. 10.1016/0300-483X(90)90106-Q.CrossRefPubMed
42.
Ishimaru H, Nabeshima T, Katoh A, Suzuki H, Fukuta T, Kameyama T: Effects of successive carbon monoxide exposures on delayed neuronal death in mice under the maintenance of normal body temperature. Biochem Biophys Res Commun. 1991, 179 (2): 836-840. 10.1016/0006-291X(91)91893-H.CrossRefPubMed
43.
Thom SR: Carbon monoxide-mediated brain lipid peroxidation in the rat. J Appl Physiol. 1990, 68 (3): 997-1003.PubMed
44.
Custodio CM, Basford JR: Delayed postanoxic encephalopathy: a case report and literature review. Arch Phys Med Rehabil. 2004, 85 (3): 502-505. 10.1016/S0003-9993(03)00471-4.CrossRefPubMed
45.
Bush G, Luu P, Posner MI: Cognitive and emotional influences in anterior cingulate cortex. Trends Cogn Sci. 2000, 4 (6): 215-222. 10.1016/S1364-6613(00)01483-2.CrossRefPubMed
46.
Carter CS, Botvinick MM, Cohen JD: The contribution of the anterior cingulate cortex to executive processes in cognition. Rev Neurosci. 1999, 10 (1): 49-57.CrossRefPubMed
47.
Devinsky O, Morrell MJ, Vogt BA: Contributions of anterior cingulate cortex to behaviour. Brain. 1995, 118 (Pt 1): 279-306.CrossRefPubMed
48.
Pillay SS, Gruber SA, Rogowska J, Simpson N, Yurgelun-Todd DA: fMRI of fearful facial affect recognition in panic disorder: the cingulate gyrus-amygdala connection. J Affect Disord. 2006, 94 (1–3): 173-181.CrossRefPubMed
49.
Pissiota A, Frans O, Michelgard A, Appel L, Langstrom B, Flaten MA, Fredrikson M: Amygdala and anterior cingulate cortex activation during affective startle modulation: a PET study of fear. Eur J Neurosci. 2003, 18 (5): 1325-1331. 10.1046/j.1460-9568.2003.02855.x.CrossRefPubMed
50.
Zhang LJ, Qi R, Zhong J, Ni L, Zheng G, Xu J, Lu GM: Disrupted functional connectivity of the anterior cingulate cortex in cirrhotic patients without overt hepatic encephalopathy: a resting state fMRI study. PLoS One. 2013, 8 (1): e53206-10.1371/journal.pone.0053206.CrossRefPubMedPubMedCentral
51.
Weiss K, Hilkenmeier F, Scharlau I: Attention and the speed of information processing: posterior entry for unattended stimuli instead of prior entry for attended stimuli. PLoS One. 2013, 8 (1): e54257-10.1371/journal.pone.0054257.CrossRefPubMedPubMedCentral
52.
Choi IS: Delayed neurologic sequelae in carbon monoxide intoxication. Arch Neurol. 1983, 40 (7): 433-435. 10.1001/archneur.1983.04050070063016.CrossRefPubMed
Metadata
Title
Structural and cognitive deficits in chronic carbon monoxide intoxication: a voxel-based morphometry study
Authors
Hsiu-Ling Chen
Pei-Chin Chen
Cheng-Hsien Lu
Nai-Wen Hsu
Kun-Hsien Chou
Ching-Po Lin
Re-Wen Wu
Shau-Hsuan Li
Yu-Fan Cheng
Wei-Che Lin
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Neurology / Issue 1/2013
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/1471-2377-13-129

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