Skip to main content
Top
Published in: Annals of Nuclear Medicine 10/2012

01-12-2012 | Original article

Regional cerebral blood flow in patients with carbon monoxide intoxication

Authors: Yu-Yu Lu, Shih-Chuan Tsai, Chia-Hung Kao, Wan-Yu Lin

Published in: Annals of Nuclear Medicine | Issue 10/2012

Login to get access

Abstract

Rationale and objectives

Early detection of regional cerebral anomalies in acute carbon monoxide (CO) poisoning by 99mTc-hexamethylprophylene amine oxime (HMPAO) brain single photon emission computed tomography (SPECT) imaging has been reported previously. However, SPECT findings varied in these studies because of their small population sizes. In this study, we included 96 patients with acute CO intoxication and analyzed the regional perfusion changes in these patients by means of HMPAO brain SPECT.

Materials and methods

Ninety-six patients, aged 4–80 years (mean age 32 years) with acute CO intoxication diagnosed by our emergency department were included in this study. Exclusion criteria included previous cerebrovascular diseases, brain injury, brain surgery and any known neurological and psychological disorders. All patients underwent a brain scan using a dual-head camera and fan-beam collimator 90–120 min after injection of 99mTc-HMPAO. Brain SPECT images were obtained for interpretation.

Results

Our data suggested that 79 of the 96 patients (82.3 %) had abnormal HMPAO brain images. The predominant site of disease was basal ganglia (52/96 = 54.2 %), followed by temporal lobe (48/96 = 50.0 %), parietal lobe (44/96 = 45.8 %), frontal lobe (30/96 = 31.2 %), occipital lobe (21/96 = 21.9 %) and thalamus (8/96 = 8.3 %). No patients with acute CO intoxication had perfusion abnormalities in the cerebellum. In addition, there was no significant difference in serum COHb levels between patients with abnormal and normal HMPAO brain images.

Conclusion

99mTc-HMPAO SPECT imaging is a useful tool to detect functional brain injury in acute CO intoxication.
Literature
1.
go back to reference 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;13:229–43.PubMedCrossRef 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;13:229–43.PubMedCrossRef
3.
go back to reference Amitai Y, Zlotogorski Z, Golan-Katzav V, Wexler A, Gross D. Neuropsychological impairment from acute low-level exposure to carbon monoxide. Arch Neurol. 1998;55:845–8.PubMedCrossRef Amitai Y, Zlotogorski Z, Golan-Katzav V, Wexler A, Gross D. Neuropsychological impairment from acute low-level exposure to carbon monoxide. Arch Neurol. 1998;55:845–8.PubMedCrossRef
4.
5.
go back to reference Hall JB, Schmidt GA, Wood LD. Principles of critical care. New York: McGraw-Hill; 1992. p. 2122. Hall JB, Schmidt GA, Wood LD. Principles of critical care. New York: McGraw-Hill; 1992. p. 2122.
7.
go back to reference Raub JA, Mathieu-Nolf M, Hampson NB, Thom SR. Carbon monoxide poisoning—a public health perspective. Toxicology. 2000;145:1–14.PubMedCrossRef Raub JA, Mathieu-Nolf M, Hampson NB, Thom SR. Carbon monoxide poisoning—a public health perspective. Toxicology. 2000;145:1–14.PubMedCrossRef
8.
go back to reference Hampson NB, Hauff NM. Carboxyhemoglobin levels in carbon monoxide poisoning: do they correlate with the clinical picture? Am J Emerg Med. 2008;26:665–9.PubMedCrossRef Hampson NB, Hauff NM. Carboxyhemoglobin levels in carbon monoxide poisoning: do they correlate with the clinical picture? Am J Emerg Med. 2008;26:665–9.PubMedCrossRef
9.
go back to reference Piantadosi CA. Diagnosis and treatment of carbon monoxide poisoning. Respir Care Clin N Am. 1999;5:183–202.PubMed Piantadosi CA. Diagnosis and treatment of carbon monoxide poisoning. Respir Care Clin N Am. 1999;5:183–202.PubMed
10.
go back to reference Destee A, Courteville V, Devos PH, Besson P, Warot P. Computed tomography and acute carbon monoxide poisoning. J Neurol Neurosurg Psychiatry. 1985;48:281–2.PubMedCrossRef Destee A, Courteville V, Devos PH, Besson P, Warot P. Computed tomography and acute carbon monoxide poisoning. J Neurol Neurosurg Psychiatry. 1985;48:281–2.PubMedCrossRef
11.
go back to reference Vion-Dury J, Jiddane M, Van Bunnen Y, Rumeau C, Lavielle J. Sequelae of carbon monoxide poisoning: an MRI study of two cases. J Neuroradiol. 1987;14:60–5.PubMed Vion-Dury J, Jiddane M, Van Bunnen Y, Rumeau C, Lavielle J. Sequelae of carbon monoxide poisoning: an MRI study of two cases. J Neuroradiol. 1987;14:60–5.PubMed
12.
go back to reference Horowitz AL, Kaplan R, Sarpel G. Carbon monoxide toxicity: MR imaging in the brain. Radiology. 1987;162:787–8.PubMed Horowitz AL, Kaplan R, Sarpel G. Carbon monoxide toxicity: MR imaging in the brain. Radiology. 1987;162:787–8.PubMed
13.
go back to reference 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;184:117–22.PubMed 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;184:117–22.PubMed
14.
go back to reference Ginsburg R, Romano J. Carbon monoxide encephalopathy: need for appropriate treatment. Am J Psychiatry. 1976;133:317–20.PubMed Ginsburg R, Romano J. Carbon monoxide encephalopathy: need for appropriate treatment. Am J Psychiatry. 1976;133:317–20.PubMed
15.
go back to reference Min SK. A brain syndrome associated with delayed neuropsychiatric sequelae following acute carbon monoxide intoxication. Acta Psychiatr Scand. 1986;73:80–6.PubMedCrossRef Min SK. A brain syndrome associated with delayed neuropsychiatric sequelae following acute carbon monoxide intoxication. Acta Psychiatr Scand. 1986;73:80–6.PubMedCrossRef
16.
go back to reference Perani D, Di Piero V, Vallar G, Cappa S, Messa C, Bottini G, et al. Technetium-99m-HMPAO SPECT study of regional cerebral perfusion in early Alzheimer’s disease. J Nucl Med. 1988;29:1507–14.PubMed Perani D, Di Piero V, Vallar G, Cappa S, Messa C, Bottini G, et al. Technetium-99m-HMPAO SPECT study of regional cerebral perfusion in early Alzheimer’s disease. J Nucl Med. 1988;29:1507–14.PubMed
17.
go back to reference Stefan H, Kuhnen C, Biersack HJ, Reichmann K. Initial experience with 99m Tc-hexamethyl-propylene amine oxime (HM-PAO) single photon emission computed tomography (SPECT) in patients with focal epilepsy. Epilepsy Res. 1987;1:134–8.PubMedCrossRef Stefan H, Kuhnen C, Biersack HJ, Reichmann K. Initial experience with 99m Tc-hexamethyl-propylene amine oxime (HM-PAO) single photon emission computed tomography (SPECT) in patients with focal epilepsy. Epilepsy Res. 1987;1:134–8.PubMedCrossRef
18.
go back to reference Lewis SW, Ford RA, Syed GM, Reveley AM, Toone BK. A controlled study of 99mTc-HMPAO single-photon emission imaging in chronic schizophrenia. Psychol Med. 1992;22:27–35.PubMedCrossRef Lewis SW, Ford RA, Syed GM, Reveley AM, Toone BK. A controlled study of 99mTc-HMPAO single-photon emission imaging in chronic schizophrenia. Psychol Med. 1992;22:27–35.PubMedCrossRef
19.
go back to reference Pozzilli C, Passafiume D, Bernardi S, Pantano P, Incoccia C, Bastianello S, et al. SPECT, MRI and cognitive functions in multiple sclerosis. J Neurol Neurosurg Psychiatry. 1991;54:110–5.PubMedCrossRef Pozzilli C, Passafiume D, Bernardi S, Pantano P, Incoccia C, Bastianello S, et al. SPECT, MRI and cognitive functions in multiple sclerosis. J Neurol Neurosurg Psychiatry. 1991;54:110–5.PubMedCrossRef
20.
go back to reference Meyer MA. Focal high uptake of HM-PAO in brain perfusion studies: a clue in the diagnosis of encephalitis. J Nucl Med. 1990;31:1094–8.PubMed Meyer MA. Focal high uptake of HM-PAO in brain perfusion studies: a clue in the diagnosis of encephalitis. J Nucl Med. 1990;31:1094–8.PubMed
21.
go back to reference Denays R, Makhoul E, Dachy B, Tondeur M, Noel P, Ham HR, et al. Electroencephalographic mapping and Tc-99m HMPAO single-photon emission computed tomography in carbon monoxide poisoning. Ann Emerg Med. 1994;24:947–52.PubMedCrossRef Denays R, Makhoul E, Dachy B, Tondeur M, Noel P, Ham HR, et al. Electroencephalographic mapping and Tc-99m HMPAO single-photon emission computed tomography in carbon monoxide poisoning. Ann Emerg Med. 1994;24:947–52.PubMedCrossRef
22.
go back to reference Kao CH, Hung DZ, ChangLai SP, Liao KK, Chieng PU. HMPAO brain SPECT in acute carbon monoxide poisoning. J Nucl Med. 1998;39:769–72.PubMed Kao CH, Hung DZ, ChangLai SP, Liao KK, Chieng PU. HMPAO brain SPECT in acute carbon monoxide poisoning. J Nucl Med. 1998;39:769–72.PubMed
23.
go back to reference Wu CI, Changlai SP, Huang WS, Tsai CH, Lee CC, Kao CH. Usefulness of 99mTc ethyl cysteinate dimer brain SPECT to detect abnormal regional cerebral blood flow in patients with acute carbon monoxide poisoning. Nucl Med Commun. 2003;24:1185–8.PubMedCrossRef Wu CI, Changlai SP, Huang WS, Tsai CH, Lee CC, Kao CH. Usefulness of 99mTc ethyl cysteinate dimer brain SPECT to detect abnormal regional cerebral blood flow in patients with acute carbon monoxide poisoning. Nucl Med Commun. 2003;24:1185–8.PubMedCrossRef
24.
go back to reference Piepsz A, Hahn K, Roca I, Ciofetta G, Toth G, Gordon I, et al. A radiopharmaceuticals schedule for imaging in paediatrics. Paediatric Task Group European Association Nuclear Medicine. Eur J Nucl Med. 1990;17:127–9.PubMedCrossRef Piepsz A, Hahn K, Roca I, Ciofetta G, Toth G, Gordon I, et al. A radiopharmaceuticals schedule for imaging in paediatrics. Paediatric Task Group European Association Nuclear Medicine. Eur J Nucl Med. 1990;17:127–9.PubMedCrossRef
25.
go back to reference Mayevsky A, Meilin S, Rogatsky GG, Zarchin N, Thom SR. Multiparametric monitoring of the awake brain exposed to carbon monoxide. J Appl Physiol. 1995;78:1188–96.PubMed Mayevsky A, Meilin S, Rogatsky GG, Zarchin N, Thom SR. Multiparametric monitoring of the awake brain exposed to carbon monoxide. J Appl Physiol. 1995;78:1188–96.PubMed
26.
go back to reference Thom SR. Carbon monoxide-mediated brain lipid peroxidation in the rat. J Appl Physiol. 1990;68:997–1003.PubMed Thom SR. Carbon monoxide-mediated brain lipid peroxidation in the rat. J Appl Physiol. 1990;68:997–1003.PubMed
27.
go back to reference Thom SR, Fisher D, Zhang J, Bhopale VM, Cameron B, Buerk DG. Neuronal nitric oxide synthase and N-methyl-d-aspartate neurons in experimental carbon monoxide poisoning. Toxicol Appl Pharmacol. 2004;194:280–95.PubMedCrossRef Thom SR, Fisher D, Zhang J, Bhopale VM, Cameron B, Buerk DG. Neuronal nitric oxide synthase and N-methyl-d-aspartate neurons in experimental carbon monoxide poisoning. Toxicol Appl Pharmacol. 2004;194:280–95.PubMedCrossRef
28.
go back to reference Ginsberg MD, Myers RE, McDonagh BF. Experimental carbon monoxide encephalopathy in the primate. II. Clinical aspects, neuropathology and physiologic correlation. Arch Neurol. 1974;30:209–16.PubMedCrossRef Ginsberg MD, Myers RE, McDonagh BF. Experimental carbon monoxide encephalopathy in the primate. II. Clinical aspects, neuropathology and physiologic correlation. Arch Neurol. 1974;30:209–16.PubMedCrossRef
29.
go back to reference Schwedenberg TH. Leucoencephalopathy following carbon monoxide asphyxia. J Neuropathol Exp Neurol. 1959;18:597–608.PubMedCrossRef Schwedenberg TH. Leucoencephalopathy following carbon monoxide asphyxia. J Neuropathol Exp Neurol. 1959;18:597–608.PubMedCrossRef
30.
go back to reference Okeda R, Funata N, Takano T, Miyazaki Y, Higashino F, Yokoyama K, et al. The pathogenesis of carbon monoxide encephalopathy in the acute phase—physiological and morphological correlation. Acta Neuropathol. 1981;54:1–10.PubMedCrossRef Okeda R, Funata N, Takano T, Miyazaki Y, Higashino F, Yokoyama K, et al. The pathogenesis of carbon monoxide encephalopathy in the acute phase—physiological and morphological correlation. Acta Neuropathol. 1981;54:1–10.PubMedCrossRef
31.
go back to reference Ozyurt G, Kaya FN, Kahveci F, Alper E. Comparison of SPECT findings and neuropsychological sequelae in carbon monoxide and organophosphate poisoning. Clin Toxicol (Phila). 2008;46:218–21.CrossRef Ozyurt G, Kaya FN, Kahveci F, Alper E. Comparison of SPECT findings and neuropsychological sequelae in carbon monoxide and organophosphate poisoning. Clin Toxicol (Phila). 2008;46:218–21.CrossRef
32.
go back to reference Weaver LK, Howe S, Hopkins R, Chan KJ. Carboxyhemoglobin half-life in carbon monoxide-poisoned patients treated with 100 % oxygen at atmosphere pressure. Chest. 2000;117:801–8.PubMedCrossRef Weaver LK, Howe S, Hopkins R, Chan KJ. Carboxyhemoglobin half-life in carbon monoxide-poisoned patients treated with 100 % oxygen at atmosphere pressure. Chest. 2000;117:801–8.PubMedCrossRef
33.
go back to reference Weaver LK, Howe S, Hopkins R, Chan KJ. Neuroimaging characteristics in carbon monoxide toxicity. J Neuroimaging. 1996;6:161–6. Weaver LK, Howe S, Hopkins R, Chan KJ. Neuroimaging characteristics in carbon monoxide toxicity. J Neuroimaging. 1996;6:161–6.
34.
go back to reference Friston KJ, Holmes AP, Worsley KJ, Poline JP, Frith CD, Frankowiak RSJ. Statistical parametric maps in functional imagines: a general linear approach. Hum Brain Mapp. 1995;2:189–210.CrossRef Friston KJ, Holmes AP, Worsley KJ, Poline JP, Frith CD, Frankowiak RSJ. Statistical parametric maps in functional imagines: a general linear approach. Hum Brain Mapp. 1995;2:189–210.CrossRef
Metadata
Title
Regional cerebral blood flow in patients with carbon monoxide intoxication
Authors
Yu-Yu Lu
Shih-Chuan Tsai
Chia-Hung Kao
Wan-Yu Lin
Publication date
01-12-2012
Publisher
Springer Japan
Published in
Annals of Nuclear Medicine / Issue 10/2012
Print ISSN: 0914-7187
Electronic ISSN: 1864-6433
DOI
https://doi.org/10.1007/s12149-012-0638-8

Other articles of this Issue 10/2012

Annals of Nuclear Medicine 10/2012 Go to the issue