Prevalence of hidden carbon monoxide poisoning in auto service workers; a prospective cohort study

Carbon monoxide poisoning: A problem uniquely suited to a medicinal inorganic chemistry solution

Carbon monoxide poisoning is one of the most common forms of poisoning in the world. Although the primary mode of treatment, oxygen therapy, is highly effective in many cases, there are instances in which it is inadequate or inappropriate. Whereas oxygen therapy relies on high levels of a low-affinity ligand (O2) to displace a high-affinity ligand (CO) from metalloproteins, an antidote strategy relies on introducing a molecule with a higher affinity for CO than native proteins (Kantidote,CO > Kprotein,CO). Based on the fundamental chemistry of CO, such an antidote is most likely required to be an inorganic compound featuring an electron-rich transition metal. A review is provided of the protein-, supramolecular complex-, and small molecule-based CO poisoning antidote platforms that are currently under investigation.

A rare case of Holmes tremor in a worker with occupational carbon monoxide poisoning

Parkinsonism and encephalopathy are frequently seen in patients who survive carbon monoxide (CO) poisoning. Neurological findings associated with CO poisoning can emerge immediately after cessation of exposure or following a brief period of pseudo-recovery. When present, the tremor associated with CO poisoning is typical of the postural/intention type. Here, we report on a rare case of toxic encephalopathy with a dominant-hand Holmes-type tremor, characterized by resting, as well as postural and kinetic/intentional components, in a previously healthy 53-year-old man exposed to CO while actively engaged in the process of performing a physically demanding skilled labor task. The unique neuropathological and functional changes that give rise to Holmes-type tremor and how this relates to the selective vulnerability of the inhibitory indirect pathway of the basal ganglia to glutamatergic excitotoxicity mediated by tissue hypoxia are discussed.

Memory Impairment and Hippocampal Volume after Carbon Monoxide Poisoning

OBJECTIVE

We report longitudinal changes in neuroimaging and neuropsychological measurements in a case of carbon monoxide (CO) poisoning showing reversible changes in hippocampal volume, which was closely linked to the degree of memory impairment.

METHODS

The current study presents a female in her early 20s, with a high school level of education. She became aware of headaches and drowsiness while working in a restaurant that operated charcoal braziers, and she was urgently transported to our hospital. Her high blood carboxyhemoglobin concentration led to a diagnosis of CO poisoning, but no obvious abnormalities were found by brain magnetic resonance imaging (MRI) and physical examinations. She underwent a series of hyperbaric oxygen therapies. One year after CO poisoning, she consulted a psychiatrist due to her own awareness of gradually worsening memory function. She was assessed by brain MRI and standard neuropsychological tests every 6 months for 1 year.

RESULTS

Her neuropsychological profile showed the impairment of memory function according to a low score of Delayed Recall Index of Wechsler Memory Scale-Revised. At 320 days after CO poisoning, her hippocampal volume had decreased by 3%. Her memory function was found to have improved at 530 days after CO poisoning. Of note, during this period, her hippocampal volume had increased by approximately 7%.

CONCLUSIONS

This report suggests that a clinician should conduct careful neuropsychological examinations to avoid overlooking mild sequelae of CO poisoning, even if a general assessment of brain MRI is normal.