Neiroradioloģiskā aina galvas smadzenēs akūtas saindēšanās gadījumos ar tvana gāzi. Klīniskā un radioloģiskā korelācija.
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Date
2022
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Akūta saindēšanās ar oglekļa monoksīdu (CO) ir izplatītākais fatālas intoksikācijas veids visā pasaulē. CO ar hemoglobīnu savienojas ar 230-270 reižu lielāku afinitāti nekā skābeklis, asinīs veidojot karboksihemoglobīnu (COHb) un sekojoši izraisot audu oksigenācijas samazinājumu. Augstās koncentrācijās gāzei ir toksiski efekti, izraisot hipoksiju, šūnu bojājumu un nāvi. Augstā metabolisma dēļ no tvana gāzes toksiskuma visvairāk cieš sirds un galvas smadzenes. Akūtas saindēšanās simptomi ir dažādi un nespecifiski. Raksturīgas galvassāpes, reibonis, mialģija vai neiropsiholoģisks bojājums. Pie smagas pakāpes saindēšanās var attīstīties apjukums, samaņas zudums vai nāve. Diagnostikā liela nozīme ir augstam aizdomu līmenim un apkārtējās vides faktoru izvērtēšanai. CO ekspozīciju apstiprina COHb līmenis asinīs, tomēr šī vērtība ar klīnisko ainu korelē vāji. Šobrīd nav specifisku un sensitīvu bioķīmisku indikatoru, kas spētu atspoguļot smadzeņu bojājuma pakāpi un prognozi pacientiem ar akūtu CO intoksikāciju. Tādēļ radioloģiskām diagnostikas metodēm ir fundamentāla diagnostika un prognostiska loma gan akūtā, gan hroniskā slimības fāzē. Mērķis: Darba mērķis bija izveidot literatūras aprakstu, kas atspoguļo klīnisko un radioloģisko simptomu korelāciju pacientiem ar akūtu CO intoksikāciju, kā arī padziļināt izpratni par akūtas CO intoksikācijas etioloģiju, iedarbības mehānismu uz galvas smadzenēm, klīniskām un laboratoriskām iespējamā smadzeņu bojājuma pazīmēm, diagnostikā pielietotajām radioloģiskām metodēm un to lietošanas indikācijām. Materiāli un metodes: Literatūras meklēšana veikta tiešsaites datu bāzēs PubMed, PubMed Central, Google Scholar ClinicalKey, ScienceDirect, kā arī izmantoti žurnāli, kā "American Journal of Neuroradiology (AINR)". Izmantotie atslēgas vārdi un frāzes angliski bija sekojoši: “carbon monoxide poisoning”, “acute”, “magnetic resonance imaging”, “MR”, “brain damage”, “computed tomography”, “CT”, “intoxication”, “carboxyhemoglobin”, “follow-up” u.c. Rezultāti: Datortomogrāfija (CT), magnētiskā rezonanse (MR), magnētiskās rezonanses spektroskopija (MRS) ir metodes, kas ir lietderīgas CO intoksikācijas izraisītu izmaiņu noteikšanai galvas smadzenēs. Magnētiskajai rezonansei ir izšķiroša loma smadzeņu bojājuma novērtēšanā. Tomēr progresējošās patoloģiskās izmaiņas galvas smadzenēs sākotnējā agrīnajā saindēšanās fāzē var būt pārāk niecīgas, lai tās atklātu CT vai konvencionālajā MR. DTI, DKI un MRS MR sekvenču pielietošana MR protokolā var sniegt jaunu, vērtīgu papildinformāciju par bojājumu raksturu, izplatību un patomorfoloģiskajām izmaiņām smadzeņu vielā. Precīzai diagnostikai ir nepieciešama radioloģiskās atradnes korelācija ar laboratorajiem datiem un klīnisko ainu.
Acute carbon monoxide (CO) intoxication is a leading cause of poisoning-related mortality worldwide. Compared with oxygen, CO binds to hemoglobin with a 230-270-fold greater affinity, competitively combining with it to form carboxyhemoglobin (COHb) with subsequent reduction of tissue oxygenation. In high concentrations it has toxic effects in humans, causing hypoxia, cell damage and death. Because of high oxygen requirement, in severe intoxications nervous and cardiovascular systems are affected most frequently. Acute CO poisoning symptoms are varied and nonspecific. Mild exposures result in headache, dizziness, myalgia or neuropsychological impairment. Severe exposures to CO result in confusion, loss of consciousness, or death. Therefore, a high index of suspicion and consideration of the environmental factors and circumstances suggestive of exposure are of paramount importance. COHb level in blood is used as a diagnostic tool to confirm CO exposure. However, COHb levels correlate poorly with the clinical picture. At present, there are no sensitive and specific biochemical indicators that may reflect the degree of brain injury and prognosis in patients with acute carbon monoxide intoxication. That is why neuroimaging has a fundamental role in the diagnosis and prognosis of this disease both in the acute and in the chronic phase. Objective: The aim of this work was to create a literature review which represents correlation between clinical and radiologic symptoms in patients with acute carbon monoxide intoxication, and to deepen understanding of acute CO intoxication etiology, mechanism of action, clinical and laboratory signs of possible brain damage, radiological methods used in diagnostics and indications for their use. Materials and Methods: The literature search was performed on online databases including PubMed, PubMed Central, Google Scholar ClinicalKey, ScienceDirect and by the use of journals including "American Journal of Neuroradiology (AJNR)". The search involved using keywords and phrases “carbon monoxide poisoning”, “acute”, “magnetic resonance imaging”, “MR”, “brain damage”, “computed tomography”, “CT”, “intoxication”, “carboxyhemoglobin”, “follow-up” etc. Results: Computed tomography (CT), magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS), are very useful to depict the presence and extension of the changes in brain tissue. Magnetic resonance imaging has as pivotal role in assessing brain injury in CO poisoning. However, in the acute phase progressively pathologic changes can be too small to be observed on computed tomography and conventional MR imaging. DTI, DKI, MRS MR sequences are more sensitive imaging methods and can give valuable information regarding changes in brain tissue due to acute CO poisoning. Nevertheless, imaging studies correlation with laboratory data and clinical history is fundamental to perform the correct diagnosis.
Acute carbon monoxide (CO) intoxication is a leading cause of poisoning-related mortality worldwide. Compared with oxygen, CO binds to hemoglobin with a 230-270-fold greater affinity, competitively combining with it to form carboxyhemoglobin (COHb) with subsequent reduction of tissue oxygenation. In high concentrations it has toxic effects in humans, causing hypoxia, cell damage and death. Because of high oxygen requirement, in severe intoxications nervous and cardiovascular systems are affected most frequently. Acute CO poisoning symptoms are varied and nonspecific. Mild exposures result in headache, dizziness, myalgia or neuropsychological impairment. Severe exposures to CO result in confusion, loss of consciousness, or death. Therefore, a high index of suspicion and consideration of the environmental factors and circumstances suggestive of exposure are of paramount importance. COHb level in blood is used as a diagnostic tool to confirm CO exposure. However, COHb levels correlate poorly with the clinical picture. At present, there are no sensitive and specific biochemical indicators that may reflect the degree of brain injury and prognosis in patients with acute carbon monoxide intoxication. That is why neuroimaging has a fundamental role in the diagnosis and prognosis of this disease both in the acute and in the chronic phase. Objective: The aim of this work was to create a literature review which represents correlation between clinical and radiologic symptoms in patients with acute carbon monoxide intoxication, and to deepen understanding of acute CO intoxication etiology, mechanism of action, clinical and laboratory signs of possible brain damage, radiological methods used in diagnostics and indications for their use. Materials and Methods: The literature search was performed on online databases including PubMed, PubMed Central, Google Scholar ClinicalKey, ScienceDirect and by the use of journals including "American Journal of Neuroradiology (AJNR)". The search involved using keywords and phrases “carbon monoxide poisoning”, “acute”, “magnetic resonance imaging”, “MR”, “brain damage”, “computed tomography”, “CT”, “intoxication”, “carboxyhemoglobin”, “follow-up” etc. Results: Computed tomography (CT), magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS), are very useful to depict the presence and extension of the changes in brain tissue. Magnetic resonance imaging has as pivotal role in assessing brain injury in CO poisoning. However, in the acute phase progressively pathologic changes can be too small to be observed on computed tomography and conventional MR imaging. DTI, DKI, MRS MR sequences are more sensitive imaging methods and can give valuable information regarding changes in brain tissue due to acute CO poisoning. Nevertheless, imaging studies correlation with laboratory data and clinical history is fundamental to perform the correct diagnosis.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Akūta oglekļa monoksīda intoksikācija; CO; saindēšanās; magnētiskā rezonanse; MR; akūts smadzeņu bojājums; datortomogrāfija; CT; karboksihemoglobīns; COHb, Acute carbon monoxide intoxication; CO; poisoning; magnetic resonance; MRI; acute brain damage; computed tomography; CT; carboxyhemoglobin; COHb