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JKM > Volume 39(3); 2018 > Article
Ryu, Kim, Lee, Cho, Yoo, Seol, and Kim: Delayed Neuropsychiatric Sequalae with Reversible Quadriplegia after Carbon Monoxide Intoxication: A Case Report

Abstract

Carbon monoxide poisoning leads to hypoxia, which eventually leads to tissue ischemia. The delayed neuropsychiatric syndrome can arise in the period from 4 days to 5 weeks following carbon monoxide poisoning. This case report describes a male who suffered from delayed sequelae after self-inflicted carbon monoxide poisoning. At the time of admission, he had symptoms of quadriplegia, both upper limb ankylosis, gait disturbance, and dysuria. He was treated with acupuncture, electro-acupuncture, physical therapy, and Uwhangchungsim-won. Paraplegia improved considerably after 7 days in hospital, and paralysis of the both upper extremities improved after 14 days in hospital. He was able to walk holding on to his wheelchair after 28 days in hospital. He was hospitalized for 55 days and was discharged from the hospital in a fine condition for everyday life. This case report suggests the possibility that korean medicine for delayed neuropsychiatric syndrome.

Fig. 1
Brain MRI DWI of the date of the incident
jkm-39-3-73f1.gif
Fig. 2
Brain MRI DWI 15 day after the incident
jkm-39-3-73f2.gif
Fig. 3
Brain MRI T2 15 day after the incident
jkm-39-3-73f3.gif
Table 1
The Progress of The Patient
Progress of the Patient
Adm. Upper limb motor weakness: Gr.3/1, Lower limb motor weakness: Gr.3/1, Finger mot(+/−), Toe mot(+/+)
8day Upper limb motor weakness: Gr.4/1, Lower limb motor weakness: Gr.4/4, Finger mot(+/+), Toe mot(+/+)
15day Upper limb motor weakness: Gr.4/3, Lower limb motor weakness: Gr.4/4
22day Upper limb motor weakness: Gr.4/3, Lower limb motor weakness: Gr.4/4,
The active ROM of the Lt. upper limb improved compared to before.
50day Upper limb motor weakness: Gr.4/4, Lower limb motor weakness: Gr.4/4,
Table 2
Korean version of Modified Barthel Index (K-MBI)
Category Adm. 8day 15day 22day 29day 36day 43day DisCharge
1, Personal hygiene 0 1 1 1 3 4 4 5
2. Bathing self 0 0 0 0 1 3 3 4
3. Feeding 0 5 5 5 8 8 10 10
4. Toilet 0 2 2 2 2 2 5 8
5. Stair climb 0 0 0 0 0 0 8 8
6. Dressing 0 0 0 2 2 5 8 10
7. Bowl control 0 5 5 5 5 8 10 10
8. Bladder control - 0 5 8 8 10 10 10
9. Ambulation 0 0 0 0 0 3 8 15
10. chair/bed transfer 0 0 0 0 1 8 12 15
Total score 0 13 18 23 30 51 78 95

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