A consideration on mechanism of selective brain damage by carbon monoxide : From the case of carbon monoxide poisoning with abnormal signal in both globus pallidus and substantia nigra by MRI, responding to Hyperbaric Oxygen Therapy

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  • Yoshizawa Hisashi
    Tokyo Metropolitan Health and Medical Treatment Corporation Ebara Hospital, Department of Radiology

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  • MRIで淡蒼球・黒質に異常信号を認め高圧酸素療法が効奏した一酸化炭素中毒の1例 : 一酸化炭素による選択的脳組織傷害機序の一考察
  • MRI デ タンソウキュウ コクシツ ニ イジョウ シンゴウ オ ミトメ コウアツ サンソ リョウホウ ガ コウソウシタ 1サンカ タンソ チュウドク ノ 1レイ 1サンカ タンソ ニ ヨル センタクテキ ノウ ソシキ ショウガイ キジョ ノ イチ コウサツ

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A 25 years old man was found lying unconscious after he got drunk and slept in front of kerosene stove. He was hospitalized for Hyperbaric Oxygen Therapy and high signal in both globus pallidus was observed by diffusion weighted image of head MRI on day 1. On day 13, high signal was also observed in both substantia nigra. Undergoing Hyperbaric Oxygen Therapy for 19 times, he made satisfactory progress and was discharged on day 34. The central nerve lesion caused by carbon monoxide poisoning is associated with iron distribution in brain (e. g. in globus pallidus, substantia nigra, cerebral white matter). The brain tissue damage by carbon monoxide poisoning is assumed to be induced by reduction ability of carbon monoxide which causes ionization of nonheme iron stored in ferritin. Ionized free nonhem iron works as catalyst for Fenton and Harber-Weiss reaction, which convert H_2O_2 to OH. The produced OH is thought to damage oligodendrocyte and myeline sheathe, ending up causing selective nerve cell death.

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