Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-10T07:27:27.606Z Has data issue: false hasContentIssue false
  • English
  • Français

Low-Level Carbon-Monoxide Poisoning: Inability of Neuropsychological Testing to Identify Patients Who Benefit from Hyperbaric Oxygen Therapy

Published online by Cambridge University Press:  28 June 2012

Steven J. Rottman ,
Nancy Kaser-Boyd ,
Timothy Cannis  and
John Alexander
Steven J. Rottman*
Affiliation:
Center for Prehospital Care, Emergency Medicine Center, UCLA Hospitals and Clinics and the UCLA School of Public Health, Los Angeles, California
Nancy Kaser-Boyd
Affiliation:
UCLA Psychology Assessment Center
Timothy Cannis
Affiliation:
Western Center for Hyperbaric Medicine, Northridge, California
John Alexander
Affiliation:
Western Center for Hyperbaric Medicine, Northridge, California
*
Emergency Medicine Center, UCLA Hospitals and Clinics, 10833 LeConte Ave., Los Angeles, CA 90024USA
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Although major sequelae of carbon-monoxide (CO) poisoning and its treatment with hyperbaric oxygen (HBO) are well-documented, a syndrome of low-level CO poisoning has received relatively little attention. Subtle symptoms of poor concentration, language difficulty, problems with calculations, and memory loss were noted after an acute exposure of 131 dormitory residents to low levels of CO. The CO Neuropsychological Screening Battery (CONSB), a series of tests reported by others as useful to identify victims of CO poisoning, was performed on a subset of 46 victims. It was hypothesized that their test scores would improve after treatment with HBO.

Methods:

Testing was performed both before and after HBO on 35 CO-exposed victims. A control group of 20 students residing on the same college campus, but not involved with the CO incident, also were tested on two separate occasions to assess the ability of the test to identify selectively victims of low-level CO poisoning, as well as to evaluate its validity when administered serially.

Results:

Both CO-exposed and control subjects demonstrated significant performance improvement when completing the testing for the second time. In addition, the baseline test scores were not significantly different for either the CO-exposed or the control groups. Nonetheless, all CO-exposed victims reported immediate subjective improvement of their symptoms after HBO therapy.

Conclusion:

These observations and a review of the literature suggest that there might exist a syndrome of subtle neurological disturbances in victims of low-level CO poisoning. Whether this is permanent or might regress spontaneously over time is unknown. As a diagnostic adjunct, the CONSB does not appear to be as useful in low-level CO poisoning.

Type
Case Report
Information
Prehospital and Disaster Medicine , Volume 10 , Issue 4 , December 1995 , pp. 276 - 282
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1995

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Olson, KR: Carbon monoxide poisoning: Mechanism, presentations, and controversies in management. J Emerg Med 1984;1:233–243.CrossRefGoogle ScholarPubMed
2. Goldsmith, JR, Landaw, SA: Carbon monoxide and human health. Science 1968;162:1352–1359.CrossRefGoogle ScholarPubMed
3. Bender, W, Gothert, M, Malory, G, et al. : Effects of low carbon monoxide concentrations in man. Arch Toxicol 1971;27:142–158.CrossRefGoogle ScholarPubMed
4. Fitzpatrick, JN: Occult carbon monoxide poisoning. West J Med 1987;146:52–56.Google Scholar
5. Myers, RA, Snyder, SK, Emhoff, TA: Subacute sequelae of carbon monoxide poisoning. Ann Emerg Med 1985;14:1163–1167.CrossRefGoogle ScholarPubMed
6. Choi, HS: Delayed neurologic sequelae in carbon monoxide intoxication. Arch Neural 1983;40:433–435.CrossRefGoogle ScholarPubMed
7. Smith, JS, Brandon, S: Morbidity from acute carbon monoxide poisoning at three year follow-up. BMJ 1973;1:318–321.CrossRefGoogle ScholarPubMed
8. Myers, RA, Mitchell, JT, Cowley, RA: Psychometric testing and carbon monoxide poisoning. Prehospital and Disaster Medicine 1983;1:279–281.CrossRefGoogle Scholar
9. Myers, RA, Messier, LD, Jones, DW, et al. : New directions in the research and treatment of carbon monoxide exposure. Am J Emerg Med 1983;2:226–230.CrossRefGoogle Scholar
10. Kindwall, EP, Goldman, RW: Hyperbaric Medicine Procedures. Milwaukee, Wis.: Department of Hyperbaric Medicine, St. Luke's Hospital, 1984, pp 90–98.Google Scholar
11. Messier, LD, Myers, RA: The CO Neuropsychological Screening Battery (CONSB): Manual of Instructions. Baltimore: The Maryland Institute for Emergency Medical Service Systems, 1985.Google Scholar
12. Haldane, J: The relationship of the action of CO to oxygen tension. J Physiol 1895;18:201–217.CrossRefGoogle Scholar
13. Ball, EG, Strittmatter, CF, Cooper, O, et al. : The reaction of cytochrome oxidase with CO. J Biol Chem 1951;193:635–647.CrossRefGoogle Scholar
14. Coburn, RF: Mechanism of carbon monoxide toxicity. Prev Med 1979;8:310–322.CrossRefGoogle ScholarPubMed
15. Thorn, SR: Hyperbaric oxygen therapy in septicemia. Journal of Hyperbaric Medicine 1987;2:141–146.Google Scholar
16. Thorn, SR: Hyperbaric oxygen inhibits neutrophil adherence to brain microvessels after carbon monoxide poisoning. Journal of Undersea and Hyperbaric Medicine Society 1993;20:16.Google Scholar
17. Norkool, DM, Kirpatrick, JN: Treatment of acute CO poisoning with hyperbaric oxygen: A review of 115 cases. Ann Emerg Med 1985;14:1168–1170.CrossRefGoogle ScholarPubMed
18. Beard, RR, Wertheim, GA: Behavioral impairment associated with small doses of CO. Am J Public Health 1967;57:2012–2022.CrossRefGoogle Scholar
19. Aronow, WS, Harris, CN, Isbell, MW, et al. : Effect of freeway travel on angina pectoris. Ann Intern Med 1972;77:669–676.CrossRefGoogle ScholarPubMed
20. Thom, SR: Carbon monoxide poisoning. Current Pulmonology 1992;13:289–309.Google Scholar
21. Thom, SR, Taber, RL, Mendiguren, I: Delayed neuropsychiatric sequelae following CO poisoning and the role of treatment with 100% O2 or hyperbaric oxygen: A prospective, randomized, clinical study. Journal of Undersea and Hyperbaric Medicine Society 1992;19:47Google Scholar
22. Gorman, DF, Clayton, D, Gilligan, JE, et al. : A longitudinal study of 100 consecutive admissions for carbon monoxide poisoning to the Royal Adelaide Hospital. Anesthesia and Intemive Care 1992;20:311–316.Google Scholar
23. Grandstaff, NW: Carbon monoxide and human functions in behavioral toxicology: Early detection of occupational hazards. U.S. Department of Commerce National Technical Information Service, 1974; PB-259322, pp 292–305.Google Scholar