A wide variety of neurological and/or psychiatric disturbances has been reported in patients surviving the acute phase of carbon monoxide (CO) poi soning, after a period of apparent recovery. Postulated pathogenic mecha nisms of these sequelae, usually referred to as 'delayed neurological syndrome' (DNS) include: (1) hypoxic-ischemic stress related to defective oxygen trans port to the cells and to impaired cardiovascular function; (2) CO interaction with intracellular targets (e.g. cytochromes) with impairment of mitochondrial electron transport; (3) brain lipid peroxidation; (4) excessive stimulation of excitatory amino acid receptors. Timely hyperbaric oxygen (HBO) treatment may interrupt the cascade of events leading to brain damage, and has been advocated as effective in preventing DNS. However, clinical studies compar ing the efficacy of hyperbaric versus normobaric oxygen have generated con flicting results and controversies regarding both the causes of delayed CO neu rotoxicity and the indications of HBO therapy. Additional clinical investiga tions and further basic research using appropriate animal models are needed.
Meredith T., Vale A.: Carbon monoxide poisoning. Br Med J1988;296:77-79.
2.
Candura F.: Elementi di Tecnologia Industriale ad Uso dei Cultori di Medicina del Lavoro . Pavia, Comet, 1991.
3.
Borst JR: Acute and chronic carbon monoxide poisoning in private motor cars and lorries . Arts Auto1970;36:1518-1523.
4.
Ramsey JM: Carboxyhemoglobinemia in parking garage employees. Arch Environ Health1967;15:580-583.
5.
Locatelli C. , Candura SM, Maccarini D., Butera R., Manzo L.: Carbon monoxide poisoning in fire victims . Indoor Environ1994;3:16-21.
6.
Seger D., Welch L.: Carbon monoxide controversies: Neuropsychologic testing, mechanism of toxicity, and hyperbaric oxygen. Ann Emerg Med1994;24:242-248.
7.
Olson KR, Seger D.: Hyperbaric oxygen for carbon monoxide poisoning: Does it really work? (editorial) . Ann Emerg Med1995;25:535-537.
8.
Myers RA, Snyder SK, Emhoff TA: Sub-acute sequelae of carbon monoxide poisoning. Ann Emerg Med1985;14:1163-1167.
9.
Choi IS: Delayed neurologic sequelae in carbon monoxide intoxication. Arch Neurol1983;40: 433-435.
10.
Yang ZD: Observation of hyperbaric oxygen in 160 patients with later manifestations after acute carbon monoxide poisoning. J Hyperb Med1986;1:188.
11.
Grinker RR: Parkinsonism following carbon monoxide poisoning. J Nerv Ment Dis1926; 64:18-28.
12.
Min SK: A brain syndrome associated with delayed neuropsychiatric sequelae following acute carbon monoxide intoxication. Acta Psychiatr Scand1986;73:80-86.
13.
Hart IK, Kennedy Pge, Adams JH, Cunning-ham NE: Neurological manifestation of carbon monoxide poisoning. Postgrad Med J1988;64: 213-216.
14.
Gorman DF, Clayton D., Gilligan JE, Webb RK: A longitudinal study of 100 consecutive admissions for carbon monoxide poisoning to the Royal Adelaide Hospital. Anaesth Intensive Care1992;20:311-316.
15.
Smith JS, Brandon S.: Morbidity from acute carbon monoxide poisoning at three-year follow-up . Br Med J1973;i:318-321.
16.
Yun DR, Park BJ, Cho S-H.: An epidemiological study of the neurological sequelae of acute carbon monoxide poisoning; in Kindwal EP (ed): Proceedings of the Eighth International Congress on Hyperbaric Medicine. San Pedro, Best Publishing , 1987 , pp 256-257.
17.
He F., Qin J., Chen S., Pan X., Xu G., Zhang S., Fang G.: Risk factors of development of delayed encephalopathy following acute carbon monoxide poisoning. Indoor Environ1992;1: 268-271.
18.
Hardy KR, Thom SR: Pathophysiology and treatment of carbon monoxide poisoning. Clin Toxicol1994;32:613-629.
19.
Douglas CG, Haldane JS, Haldane Jbs: The laws of combination of haemoglobin with carbon monoxide and oxygen . J Physiol1912;44: 275-304.
20.
Ginsberg MD , Myers RE, McDonagh BF: Experimental carbon monoxide encephalopathy in the primate. II. Clinical aspects, neuropathology and physiologic correlation . Arch Neurol1974;30:209-216.
21.
Olson KR: Carbon monoxide poisoning: Mechanisms, presentation and controversies in management . J Emerg Med1984 ; 1:233-243.
22.
Goldbaum LR , Ramirez RG, Absalon KB: What is the mechanism of carbon monoxide toxicity?Aviat Space Environ Med1975;46: 1289-1291.
23.
Somogyi E., Balogh I., Rubanyi G., Sotonyi P., Szegedi L.: New findings concerning the pathogenesis of acute carbon monoxide (CO) poisoning . Am J Forensic Med Pathol1981;2:31-39.
Lipton SA, Rosenberg PA: Excitatory amino acids as a final common pathway for neurological disorders . N Engl J Med1994;330:613-622.
26.
Ishimaru H. , Katoh A., Suzuki H., Fikuta T., Kameyama T.: Effects of N-methyl-D-aspartate receptor antagonists on carbon monoxide-induced brain damage in mice. J Pharmacol Exp Ther1992 ;261:349-352.
27.
Dugan LL, Choi DW: Excitotoxicity, free radicals and cell membrane changes. Ann Neurol1994;35:17-21.
28.
Götz ME, König G., Riederer P., Youdim Mbh: Oxidative stress: free radical production in neural degeneration. Pharmacol Ther1994;63: 37-122.
Brown SD, Piantadosi CA: In vivo binding of carbon monoxide to cytochrome c oxidase in rat brain. J Appl Physiol1990;68:604-610.
31.
Thom SR: Antagonism of carbon monoxide-mediated brain lipid peroxidation by hyperbaric oxygen. Toxicol Appl Pharmacol1990; 105:340-344.
32.
Thom SR: Functional inhibition of leukocyte B2 integrins by hyperbaric oxygen in carbon monoxide-mediated brain injury in rats. Toxicol Appl Pharmacol1993;123:248-256.
33.
Tomaszewski C., Rudy J., Wathen J.: Prevention of neurologic sequelae from carbon monoxide by hyperbaric oxygen in rats. Ann Emerg Med1992;21:631-632.
34.
Thom SR, Mendiguren I., Nebolon M.: Temporary inhibition of human neutrophil B2 integrin function by hyperbaric oxygen (HBO). Clin Res1994;42:130A.
35.
Roche L., Bertoye A., Vincent P., Motin J., Garin JP, Bolot JF, Chadenson O.: Comparaison de deux groupes de vingt intoxications oxycarbonées traitées par oxygène normobare et hyper-bare. Lyon Méd1968;49:1483-1499.
36.
Mathieu D., Nolf M., Durocher A., Saulnier F., Frimat P., Furon D., Wattel F.: Acute carbon monoxide poisoning: Risk of late sequelae and treatment by hyperbaric oxygen. Clin Toxicol1985;23:315-324.
37.
Willms SJ, Turner F., Kerr J.: Carbon monoxide or smoke inhalation treated with oxygen (hyperbaric vs normobaric): 118 reviewed. UnderseaBiomed Res1985;12:S56.
38.
Tibbles PM, Perrotta PL: Treatment of carbon monoxide poisoning: a critical review of human outcome studies comparing normobaric oxygen with hyperbaric oxygen. Ann Emerg Med1994;24:269-276.
39.
Raphael JC, Elkharrat D., Jars-Guincestre MC, Chastang C., Chasles V., Vercken JB, Gajdos P.: Trial of normobaric and hyperbaric oxygen for acute carbon monoxide intoxication . Lancet1989;i:414-419.
40.
Brown SD, Piantadosi CA: Hyperbaric oxygen for carbon monoxide poisoning (letter). Lancet1989;ii:1032.
Neubauer RA , Gottlieb SF: Hyperbaric oxygen for carbon monoxide poisoning (letter). Lancet1989;ii:1032-1033.
43.
Ducassé JL, Izard PH, Celsis P.: Moderate carbon monoxide poisoning: hyperbaric or normobaric oxygenation? Human randomised study with tomographic cerebral blood flow measurement; in Schmutz J, Bakker D (eds): Proceedings of the 2nd Swiss Symposium on Hyperbaric Medicine. Basel, Foundation for Hyperbaric Medicine, 1990, pp 289-297.
44.
Thom SR, Taber RL, Mendiguren II, Clark JM, Hardy KR, Fisher AB: Delayed neuropsychologic sequelae after carbon monoxide poisoning: Prevention by treatment with hyperbaric oxygen. Ann Emerg Med1995 ;25:474-480.
45.
Goulon M., Barois A., Rapin M., Nouailhat F., Grosbuis S., Labrousse J.: Intoxications oxycarbonées et anoxies aigues par inhalation de gaz de charbon et d'hydrocarbures. Ann Méd Interne1969;120:335-349.
46.
Van Meter KW , Harch PG, Andrews LC Jr, Simanonok JP, Staab PK, Gottlieb SF: Should the pressure be off or on in the use of oxygen in the treatment of carbon monoxide-poisoned patients?Ann Emerg Med1994;24:283-288.
