Roger Denays

Electroencephalographic mapping and 99mTc HMPAO single-photon emission computed tomography in carbon monoxide poisoning

STUDY OBJECTIVE To investigate whether topographic analysis of EEG mapping and technetium-99m (99mTc) hexamethylpropylenamine oxide (HMPAO) brain single-photon emission computed tomography (SPECT) can detect cerebral anomalies in the acute phase of carbon monoxide poisoning. DESIGN Twelve patients aged 18 to 55 years with severe carbon monoxide poisoning and no history of neurologic disorder were evaluated. Either nasal (5 patients) or hyperbaric (7 patients) oxygen therapy was administered. Criteria for hyperbaric oxygen therapy were blood CO of more than 20%, loss of consciousness, pregnancy, or signs of cardiac injury. After oxygen treatment, all patients had a blood CO value of 0% and no patient had persistent acute signs of toxicity. Patients then were investigated by confentional EEG, EEG mapping, and 99mTc HMPAO brain SPECT. These procedures were performed on the day of admission. PARTICIPANTS After nasal (5 patients) or hyperbaric (7 patients) oxygen therapy was administered, 12 adults with severe carbon monoxide poisoning were evaluated. All studies were performed on the day of admission. MEASUREMENTS Conventional EEG, EEG mapping, and 99mTc HMPAO brain SPECT. RESULTS While classic EEG was normal in 9 of 12 patients and showed diffuse anomalies in 3, EEG mapping and 99mTc HMPAO brain SPECT demonstrated unilateral or bilateral regional anomalies in 8 of 12 patients. Anomalies were localized in temporo-parieto-occipital areas, the watershed areas of the major cerebral arteries, or in temporal cortex. CONCLUSION These preliminary results suggest that EEG mapping and 99mTc HMPAO brain SPECT can be complementary tools to diagnose early regional cerebral anomalies in carbon monoxide-poisoned patients.

Bilateral cerebral mediofrontal hypoactivity in Tc-99m HMPAO SPECT imaging.

Fifteen patients who had bilateral mediofrontal hypoactivity and 30 control subjects without this SPECT anomaly underwent Tc-99m HMPAO brain SPECT imaging. Bilateral mediofrontal hypoactivity was found in various neurologic disorders, Including subcortical arteriosclerotic encephalopathy, lacunar state, chronic alcoholism, progressive nonvascular dementia, carbon monoxide poisoning, and diabetes mellltus. This SPECT abnormality was, however, specifically associated with three clinical signs: motor disabilities predominating in the lower limbs, urinary incontinence, and akinetic mutism.

First Epileptic Seizure Induced by Occupational Nickel Poisoning

Summary:  Toxic causes of seizures are numerous: alcohol and other substances of abuse, drugs, and industrial and household products. However, in the absence of a clearly suggestive history and/or associated symptoms and signs, identification of the toxic origin of new‐onset seizures may be extremely difficult. We report here the case of a patient admitted in our hospital after a single generalized tonic–clonic seizure. The remarkable coincidence that a colleague of his, with whom he was working to clean the same workshop, had been admitted 1 week earlier for respiratory distress, coma, and de novo nonconvulsive focal status epilepticus, led us to consider a possible toxicologic etiology. Urine analysis revealed a high nickel concentration, suggestive of acute nickel poisoning.