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Open Access Research article

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

Hsiu-Ling Chen12, Pei-Chin Chen1, Cheng-Hsien Lu3, Nai-Wen Hsu4, Kun-Hsien Chou5, Ching-Po Lin25, Re-Wen Wu6, Shau-Hsuan Li7, Yu-Fan Cheng1 and Wei-Che Lin12*

Author Affiliations

1 Departments of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, 83305, Niao-Sung, Kaohsiung, Taiwan

2 Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan

3 Departments of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan

4 Department of Radiology, Yuan's General Hospital, Kaohsiung, Taiwan

5 Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan

6 Departments of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan

7 Departments of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan

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BMC Neurology 2013, 13:129  doi:10.1186/1471-2377-13-129

Published: 1 October 2013

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.

Keywords:
Carbon monoxide intoxication; Cognitive deficits; Delayed encephalopathy; Magnetic resonance imaging; Voxel-based morphometry