Akathisia induced by necrosis of the basal ganglia after carbon monoxide intoxication

"Unvoluntary" Movement Disorders: Distinguishing between Tics, Akathisia, Restless Legs, and Stereotypies

Tics, stereotypies, akathisia, and restless legs fall at different places on the spectrum of discrete, unwanted and potentially disabling motor routines. Unlike tremor, chorea, myoclonus, or dystonia, this subgroup of abnormal movements is characterized by the subject's variable ability to inhibit or release undesired motor patterns on demand. Though it may be sometimes clinically challenging, it is crucial to distinguish these "unvoluntary" motor behaviors because secondary causes and management approaches differ substantially. To this end, physicians must consider the degree of repetitiveness of the movements, the existence of volitional control, and the association with sensory symptoms, or cognitive-ideational antecedent. This review aims to summarize the current existing knowledge on phenomenology, diagnosis, and treatment of tics, stereotypies, akathisia, and restless leg syndrome.

Neuroimaging, Cognitive, and Neurobehavioral Outcomes Following Carbon Monoxide Poisoning

Carbon monoxide is a colorless, odorless gas produced as a byproduct of combustion. Carbon monoxide is the leading cause of poisoning injury and death worldwide. Morbidity following CO poisoning includes neurologic sequelae, neuropathologic abnormalities on brain imaging, neurobehavioral changes, and cognitive impairments. It is estimated that as high as 50% of individuals with carbon monoxide poisoning will develop neurologic, neurobehavioral, or cognitive sequelae. Carbon monoxide related cognitive impairments included impaired memory, attention, executive function, motor, visual spatial, and slow mental processing speed. Given the high rate of brain related morbidity and the fact that the majority of carbon monoxide is avoidable, awareness and prevention of carbon monoxide poisoning is warranted.

Basal ganglia lesions following carbon monoxide poisoning

PRIMARY OBJECTIVES

Carbon monoxide (CO) is the most common cause of poisoning and may result in basal ganglia lesions. This study reviewed the literature of carbon monoxide poisoning and basal ganglia lesions and prospectively assessed the prevalence of basal ganglia lesions in a cohort of patients with CO poisoning.

RESEARCH DESIGN

Literature review and prospective cohort study.

METHODS

This study conducted a comprehensive review of the literature and assessed 73 CO-poisoned patients for basal ganglia lesions on sequential MR scans. Magnetic resonance scans were obtained on day 1, 2 weeks and 6 months post-CO poisoning.

RESULTS

The literature review found basal ganglia lesions occur in 4-88% of subjects. Only one patient was found with globus pallidus lesions at 2 weeks and 6 months following CO poisoning, that were not present on the initial day 1 MR scan.

CONCLUSIONS

Basal ganglia lesions, including lesions of the globus pallidus, may be less common than previously reported.

Carbon-monoxide poisoning, behavioural changes and suicide: an unusual industrial accident

We report a case of CO intoxication caused by a motor vehicle's faulty heating-system. A truck driver experienced severe mental deterioration, behavioural changes and delirium after acute CO intoxication and committed suicide 15 months later. This report examines the pathogenetic mechanism of CO, the immediate and delayed consequences of CO intoxication, diagnostic difficulties and current treatment options. The medical-legal aspects of the case are discussed.

Post-hypoxic recovery of acetylcholine release: different sensitivity of guinea pig neocortical and striatal slices

The release of endogenous acetylcholine (ACh) was measured in superfused guinea-pig cortical and striatal slices, kept at rest or electrically stimulated at different frequencies, before and during severe hypoxic conditions as well as after reoxygenation. In the cortex the basal release was unchanged by 30-60 min of hypoxia while it was inhibited in the striatum. The release evoked by short-term (2 min) stimulation at 0.5 Hz was moderately reduced (to 76%) by 30 min hypoxia in the cortex and in the striatum, but fully recovered after reoxygenation. The release evoked by continuous stimulation (from 5 to 10 to 20 Hz) was strongly inhibited (to 12-30%) in both areas after 30 min of hypoxia. After 30 min of reoxygenation, the recovery was complete in the cortex (mainly provided with cholinergic axons), but it was incomplete in the striatum (rich in cholinergic interneurones). The extent of the recovery in the latter area (i) was inversely related to stimulation frequency, (ii) did not depend on the depletion of neurotransmitter stores, because ACh tissue levels were fully restored by reoxygenation, and (iii) was consistently facilitated by excitatory aminoacid antagonists, slightly improved by the adenosine agonist R-phenylisopropyladenosine and unaffected by reducing the concentrations of radical species with catalase and superoxide dismutase or N omega-nitro-L-arginine. These results emphasize (i) the different vulnerability of the cortical and striatal cholinergic structures, (ii) the high sensitivity of the striatal interneurones to the frequency of stimulation during the posthypoxic recovery, and (iii) the relevant role played by endogenous glutamate on activity-dependent neurosecretory failure.