Delayed Neurological Sequelae after Carbon Monoxide Poisoning
Carbon Monoxide Delayed Neurological Sequelae
Delayed Neurological Sequelae of carbon monoxide poisoning, called DNS, can result in sufferers getting much worse over weeks after hospital discharge.
One of the most disturbing aspects of carbon monoxide poisoning is the onset of delayed Neurological symptoms. Brain damage after carbon monoxide does not occur at the event but evolves over days and weeks after the exposure. Behavioral and neurologic deficits worsen two to 40 days after the poisoning. Too many carbon monoxide poisoning patients are discharged from the hospital on the day of poisoning with no warning about the potential for a severe relapse of symptoms. DNS is an escalating pathology. The toxic effects of CO poisoning continue to attack the neurological system and particularly the brain, for many weeks after the initial exposure. This syndrome, sometimes called DNS (for Delayed Neurologica Sequelae) can materialize as any neurological or behavioral symptom, including memory loss, confusion, seizures, urinary incontinence, loss of bowel function, disorientation, hallucinations, psychosis and balance and dizziness.
It is believed that DNS is related to “brain lipid peroxidation” which may be a result of carbon monoxide triggering a Nitric Oxide formation in the blood stream.
It is important that the potential for Delayed Neurologica Sequelae in all carbon monoxide exposure cases be explained. The potential for Delayed Neurological Sequelae should be monitored carefully. The longer a patient is unconscious, the more likely DNS may occur. There is also a dramatic increased risk of DNS with patients over 30. The prevalence of Delayed Neurologica Sequelae is significantly understated, as the studies that have looked at neuropsychometric (neuropsychological testing) measures, versus strictly clinical manifestations, the percentage of those with DNS climbs to nearly 50%.
THE DIAGNOSIS OF PERMANENT BRAIN DAMAGE IS SUBTLE, AND IT CANNOT BE RULED OUT BY NORMAL NEUROLOGICAL EXAMS OR IMAGING STUDIES.