Delayed Neuropsychiatric Sequalae with Reversible Quadriplegia after Carbon Monoxide Intoxication : A Case Report

Ju Young Ryu; Min Ji Kim; Kang Wook Lee; Hyun Kyoung Cho; Ho Ryong Yoo; In Chan Seol; Yoon Sik Kim; Ryu, Ju Young; Kim, Min Ji; Lee, Kang Wook; Cho, Hyun Kyoung; Yoo, Ho Ryong; Seol, In Chan; Kim, Yoon Sik

doi:10.13048/jkm.18026

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

Case Report

The Journal of Korean Medicine 2018; 39(3): 73-80.

Published online: September 30, 2018

DOI: https://doi.org/10.13048/jkm.18026

Delayed Neuropsychiatric Sequalae with Reversible Quadriplegia after Carbon Monoxide Intoxication: A Case Report

Ju Young Ryu, Min Ji Kim, Kang Wook Lee, Hyun Kyoung Cho, Ho Ryong Yoo, In Chan Seol, Yoon Sik Kim

Department of Circulatory Internal Medicine, College of Korean Medicine, Daejeon University

Correspondence to：김윤식(Yoon Sik Kim) 충남 천안시 서북구 노태산로 4 대전대부속천안한방병원 Tel: +82-41-521-7536, Fax: +82-41-521-7007, E-mail: yoonsik@dju.kr

Received July 27, 2018 Revised August 30, 2018 Accepted September 7, 2018

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.

Keywords: Case report, Delayed neuropsychiatric syndrome, Quadriplegia, Acupuncture, Uwhangchungsim-won

Fig. 1

Brain MRI DWI of the date of the incident

Fig. 2

Brain MRI DWI 15 day after the incident

Fig. 3

Brain MRI T2 15 day after the incident

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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