Case - Carbon Monoxide Poisoning
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This is an example of carbon monoxide poisoning.
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These are images of a 49-year-old male who is
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found in his camper, minimally responsive
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next to a charcoal grill.
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So, the concern was carbon monoxide poisoning.
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These are the diffusion-weighted images and ADC Maps.
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The cerebellum looks normal,
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temporal lobes, frontal lobes look normal,
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but as we get to the basal ganglia,
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you can see restricted diffusion characterized
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by hyperintensity on the diffusion-weighted
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images and hypo-intensity on the ADC maps
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in the bilateral Globus pallidus.
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Rest of the brain looks normal,
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except there are tiny foci of restricted
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diffusion peripherally,
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but given that he was exposed to carbon monoxide,
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which again replaces oxygen
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on the hemoglobin molecule so that you get hypoxic.
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These findings are consistent with
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early carbon monoxide poisoning.
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When it gets more severe, it will involve the
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rest of the deep gray nuclei and cortex.
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We can also see these findings on the FLAIR
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and T2-weighted images,
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where they are characterized by hyperintensity
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in the bilateral Globus Pallidus.
Pamela W Schaefer, MD, FACR
Professor of Radiology, Vice Chair of Education
Massachusetts General Hospital
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