Parkinson’s syndrome in a girl after carbon monoxide intoxication

Abstract

Parkinson’s syndrome can be caused by different causes, which lead to damage of the extrapyramidal system (genetic factors, acute or chronic encephalitis, mangane or carbon monoxide poisoning). The aim of the paper is to present a clinical case with Parkinson’s syndrome as a delayed neurological complication after acute carbon monoxide intoxication.
A 16 year old girl with normal premorbide development was found with a convulsions, followed by unconsciousness and dizziness, due to carbon monoxide рoisoning from gas heater. From the 4th day she developed secondary generalised tonic-clonic seizures, from the 6th day- cerebellar syndrome with severe ataxia of gait, somnolence and cognitive impairment, related to the hypoxic- ischemic injury of central nervous system during carbon monoxide рoisoning and high doses of the anticonvulsive drugs treatment. Magnetic resonance imaging (MRI), performed at the 19th day after the intoxication revealed bilateral symmetric hyperintense lesions in T2 and FLAIR in putamen and nucleus caudatus. During the next 30 days the girl developed Parkinson’s syndrome and remained ataxic. The muscle rigidity decreased during 3 months of follow-up, while the cognitive impairment persisted.
Conclusions: The presented case demonstrate the typical delayed consequences from the acute carbon monoxide poisoning, characterized by development of cognitive impairment and Parkinson’s syndrome one month after the intoxication and MRI data of bilateral lesions in the basal ganglia. This visualized bilateral lesions in putamen and nucleus caudatus are more rarely reported as localization of hypoxic- ischemic injury in the carbon monoxide intoxication.