Neurological sequelae in acute carbon monoxide poisoning: A prospective observational study with MRI data

Objectives Acute carbon monoxide (CO) poisoning survivors may experience persistent neurological sequelae (PNS) and delayed neurological sequelae (DNS). This study evaluated the clinical features, laboratory results, acute brain lesions (ABLs) on diffusion‐weighted imaging (DWI) at presentation, and long‐term outcomes and explored differences between patients with PNS and DNS. Methods The study included 443 patients who had experienced CO poisoning, underwent DWI and completed 1‐year follow‐ups. The demographics, comorbidities, symptomatology, laboratory results, ABLs on DWI at presentation, and long‐term outcomes were compared between patients with PNS and those with DNS. Results The 42 (9.5%) and 96 (21.7%) patients with PNS and DNS, respectively, showed no significant differences in demographics, duration of CO exposure, initial conscious level, symptomatology, and laboratory results. ABLs on DWI were observed in 33 patients (33/42) with PNS and 62 patients (62/96) with DNS. The most common region of ABLs was the globus pallidus (60.6% and 56.6% in PNS and DNS, respectively). The proportion of ABLs present and lesion distribution did not differ significantly between the two groups. At 1 year, a significantly higher proportion of patients in the PNS group showed a good outcome (defined as modified Rankin Scale [mRS] scores of 0–2, 81%) compared with the DNS group (81% vs. 56.3%, p = .047). Conclusion Demographics, clinical features, laboratory results, and acute brain lesions on MRI at presentation did not differ between the PNS and DNS groups. However, the long‐term outcome of PNS was better than that of DNS.