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HMPAO SPECT Brain Imaging-Guided HBOT in the Treatment of Neurological Residual of Carbon Monoxide Poisoning

Paul G. Harch, Keith Van Meter, Paul K Staab, Sheldon F. Gottlieb, Jo Ellen Smith Medical Center, New Orleans, LA.

Introduction:

There is no accepted treatment for neurological residual of carbon monoxide poisoning; this report documents the effect of Hyperbaric Oxygen Therapy (HBOT) for established neurological residual.

Methods:

5 adult males (29-51-yrs old) presented 6-10 months after CO poisoning. 4 were group poisoned (1 episode), the 5th was poisoned dozens of times over 3.5 years. All had cognitive, neurological, and constitutional symptoms with primarily balance, gait, and coordination abnormalities on physical exam. SPECT brain imaging was performed on an ADAC dual-head or Picker Prism 3000 triple head scanner pre and post 1 HBOT and at the end of an HBOT course at 1.5 ATA/60-90 minutes/q.d.-b.i.d. (38, 31, 33, 34, 80 treatments). Baseline MRI's and neuropsychological tests (pre and post HBO course--4/5 patients) were obtained.

Results:

  • 1/5 MRI's was abnormal (white matter T2 signals) and unchanged after treatment.
  • All baseline SPECT's were abnormal, improved after (1) HBOT dive, and at the end of treatment.
  • Neuro-psych testing was abnormal pre- and improved post-HBOT.
  • 4 of 5 patients showed emotional liability between 15-20 HBOT dives which abated with further treatment.
  • Mild deterioration occurred after 25 treatments in 2/5 patients and a third patient showed partial regression 2 months post discontinuation of HBOT.

Conclusion:

  • HBOT can improve neurological/cognitive residual of CO poisoning when delivered months after the poisoning.
  • SPECT brain imaging pre and post (1) HBOT dive predicted this improvement and tracked the clinical course.
  • Peak symptom improvement occurred approximately 25-30 HBOT's with some emotional liability occurring at 15-20 HBOT's.

 

1995 UHMS Gulf Coast Chapter Annual Meeting, New Orleans, LA Mar 30 - Apr 2, 1995