Case report: Reversible neuropsychological impairment after severe carbon monoxide poisoning in a child

Abstract

Carbon monoxide (CO) intoxication can cause significant neuropsychological deficits in adults acutely or as delayed sequelae after a symptom‐free period of up to 40 days. However, there are few data available regarding the effects of CO poisoning in children during the same time period. We studied a 10‐year‐old girl who suffered severe CO intoxication over at least 36 hr. Neurobehavioral examination at 2 weeks postonset revealed specific impairments in functions associated with the frontal and parietal areas. Follow‐up examinations throughout the next 4 weeks revealed recovery of all functions to estimated premorbid levels. This recovery was maintained at 6 months and 1 year following the hypoxic episode. The results suggest (a) a multifocal pattern of results similar to that reported in adults and (b) an immediate onset and rapid reversibility of symptoms with no delayed sequelae up to 1 year later, a finding different from that in adults. Together with findings from animal studies, the data (a) raise the possibility that select brain areas at the border of vascular territories in the frontal and parietal lobes are more susceptible to CO injury and (b) support the notion that delayed sequelae may be more probable with age. Developmental cerebral plasticity may account for some of the difference in recovery between this child and adults.