Objective: To investigate prospectively the nigrostriatal system in patients with delayed post-anoxic Parkinsonism by TRODAT-1 brain SPECT serially and to correlate the neuropsychiatric performance and the nigrostriatal system in patients following carbon monoxide (CO) poisoning.

Background: Delayed neuropsychiatric syndrome (DNS) may develop later following a symptom-free interval of 1 to 3 weeks after CO poisoning. Parkinsonism has been reported to occur in 9.5% patients following CO poisoning. The 99mTc-TRODAT-1 binds to the dopamine transporter and can be used in neuroimaging as in vivo marker of dopaminergic system.

Methods: We studied 11 patients with CO poisoning (6 men, 5 female) with mean age 43.5 years (range 20 to 64 years) and 8 age-matched healthy subjects (mean age 46.3 years) as controls. Detailed neurological examination, cognitive tests, UPDRS motor score, brain MRI and TRODAT-1 brain SPECT were performed on presentation, at 2nd month and 9th month serially. Analysis of variance (ANOVA) was performed to statistically compare the longitudinal difference of clinical data and TRODAT-1 binding ratio in patients with and without DNS.

Results: FLAIR MRI of brain revealed hypersignal lesions in bilateral globus pallidus in 4 patients and bilateral periventricular white matters in 6 patients. Five patients met the criteria for DNS. For the five patients with DNS, all of them have Parkinsonism and impaired cognitive function. Reduced mental test scores at subacute stage was found in patients with DNS compared to patients without DNS and normal subjects. Interestingly, there was delayed white matter lesions on followed up MRI in 3 patients without DNS clinically at subacute stage. There was no correlation between the radiological findings and the development of parkinsonism. There was a reduction in bilateral striatal DAT binding in patients with and without DNS compared with normal subjects. There was significant difference of bilateral striatal DAT binding between patients with DNS and without DNS at acute stage after CO exposure.

Conclusions: DAT brain SPECT is useful in monitoring the development of DNS and the reduction of striatal DAT binding is more severe at the acute stage in patients with DNS.

References: 1. Gale SD, Hopkins RO, Weaver LK, Bigler ED, Booth EJ, Blatter DD. MRI, quantitative MRI, SPECT, and neuropsychological findings following carbon monoxide poisoning. Brain Injury 1999, 13(4):229-243. 2. Rissanen E, Paavilainen T, Virta J, Marttila RJ, Rinne JO, Airas L. Carbon monoxide poisoning-induced nigrostriatal dopaminergic dysfunction detected using positron emission tomography (PET). Neurotoxicology. 2010 Aug;31(4):403-7.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/carbon-monoxide-poisoning-induced-parkinsonism-a-prospective-study-of-clinical-and-neuroimage-correlation/