Jeon SB, et al. - This study was performed to determine whether acute brain lesions on diffusion-weighted imaging were associated with subsequent development of delayed neurological sequelae after acute carbon monoxide poisoning. Researchers found a significant association between the presence of acute brain lesions with the development of delayed neurological sequelae. During the acute phase of carbon monoxide poisoning, diffusion-weighted imaging could, therefore, help in identifying patients at risk of developing these debilitating sequelae.

Methods

• The researchers conducted this registry-based observational study at a university hospital in Seoul, Korea, between April 1, 2011, and December 31, 2015.
• A total of 433 patients (61.9%) who underwent diffusion-weighted imaging at an emergency department among the 700 patients (aged ≥18 years) who had acute carbon monoxide poisoning, were considered for the study.
• They excluded patients who developed cardiac arrest before diffusion-weighted imaging (n = 3), had persistent neurological symptoms at discharge (n = 8), committed suicide soon after discharge (n = 1), and were lost to follow-up (n = 34).
• They looked for the presence of unambiguous, high-signal-intensity, acute brain lesions on diffusion-weighted imaging (b = 1000 s/mm²).
• Main outcome was development of delayed neurological sequelae defined as any neurological symptoms or signs that newly developed within 6 weeks of discharge.

Results

• Acute brain lesions on diffusion-weighted imaging were observed in 104 patients (26.9%) among the 387 included patients (143 women [37.0%]; median age, 42.0 years [interquartile range, 32.0-56.0 years]).
• Of these 104 patients, 77 patients (19.9%) had globus pallidus lesions, 13 (3.4%) had diffuse lesions, and 57 (14.7%) had focal lesions (37 patients [9.6%] had >1 pattern concurrently).
• Supratentorial and infratentorial lesions were noted in 101 and 23 patients, respectively.
• In 101 patients (26.1%), delayed neurological sequelae occurred.
• In multivariable logistic regression analysis, the presence of acute brain lesions was independently correlated with development of delayed neurological sequelae (adjusted odds ratio, 13.93; 95% CI, 7.16-27.11; P < .001).
• To evaluate the probability of delayed neurological sequelae, the sensitivity and specificity of acute brain lesions were 75.2% (95% CI, 66.8%-83.7%) and 90.2% (95% CI, 86.8%-93.7%), respectively.
• Furthermore, the positive and negative predictive values were 73.1% (95% CI, 64.6%-81.6%) and 91.2% (95% CI, 87.9%-94.5%), respectively.