Objective: To report delayed onset parkinsonism in carbon monoxide intoxication.

Background: Secondary parkinsonism as a delayed neurological sequel (DNS) after gas or chemical substance exposure is rare. Such cases were mostly related to carbon monoxide intoxication from fire accidents. In Italy, from 347 patients involved in fire accidents from 1992 to 2007, 34 patients (24.1%) presented with DNS in a 6-month follow-up. But only 7 (2%) patients showed movement disorder symptoms. This is a case of a young male with delayed onset parkinsonism, 1 month after a house fire accident.

Method: A case report.

Results:

A 26-year-old male, came to the neurology clinic of Dr. Cipto Mangunkusumo Hospital with symmetric bradykinesia and rigidity, predominant in lower extremities. He also had gait impairment, postural instability, and mild cognitive impairment (executive function and delayed memory recall). The patient was involved in a fire accident 1 month prior, admitted to the intensive care unit (ICU) with respiratory distress, and was ventilated due to inhalant trauma. In the second week, bradykinesia and gait impairment became more apparent, followed by difficulty in maintaining his balance. 

Brain MRI showed T1WI low-intensity lesions in bilateral globus pallidus, that became high intensity on the T2 and T2 flair sequences, suggestive for carbon monoxide intoxication (COI). The symptoms and brain MRI lesisons persisted 3 months later. 

DNS after COI may include variable degrees of focal neurological deficits and parkinsonian symptoms, and in addition to cognitive decline. DNS may develop later following a symptom-free interval for 1-3 weeks. Incidence of parkinsonism varied from 2 to 9.5% of patients following COI. Full recovery is expected after 6-12 months of follow-up, although parkinsonian symptoms persisted in 3 of 16 patients (18%).

Conclusion: Delayed parkinsonism and cognitive impairment may occur as a part of DNS. The prognosis should be determined in a longer follow-up, approximately 6-12 months.

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References: [1]. Pepe G, Castelli M, Nazerian P, Vanni S, Del Panta M, Gambassi F, et al. Delayed neuropsychological sequelae after carbon monoxide poisoning: predictive risk factors in the Emergency Department. A retrospective study. Scand J Trauma Resusc Emerg Med 2011;19:1–8. https://doi.org/10.1186/1757-7241-19-16.
[2]. LI J-Y, Chou M-C, Lai P-H. Carbon Monoxide Poisoning-Induced Parkinsonism: A Prospective Study of Clinical and Neuroimage Correlation. Mov Disord 2018;1:2.
[3]. Martani L, Giovanniello A, Bosco G, Cantadori L, Calissi F, Furfaro D, et al. Delayed Neurological Sequelae Successfully Treated with Adjuvant, Prolonged Hyperbaric Oxygen Therapy: Review and Case Report. Int J Environ Res Public Health 2022;19. https://doi.org/10.3390/ijerph19095300.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/delayed-parkinsonism-as-a-delayed-neurological-sequele-in-carbon-monoxide-intoxication-a-rare-case-report/