Bilateral brachial plexus injury following acute carbon monoxide poisoning

Carbon monoxide (CO) intoxication is a leading cause of severe neuropsychological impairments. Peripheral nerve injury has rarely been reported. It consists usually in a demyelinating polyneuropathy or mononeuropathy affecting mainly the lower limbs. Isolated involvement of both upper extremities ha...

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Bibliographic Details
Published in:	BMC pharmacology & toxicology Vol. 14; no. 1; p. 61
Main Authors:	Rahmani, Mounia, Belaidi, Halima, Benabdeljlil, Maria, Bouchhab, Wafa, El Jazouli, Nadia, El Brini, Asmae, Aidi, Saadia, Ouazzani, Reda M, El Alaoui Faris, Mustapha
Format:	Journal Article
Language:	English
Published:	England BioMed Central Ltd 07-12-2013 BioMed Central
Subjects:	Acute Disease Adult Brachial Plexus Neuropathies - diagnosis Brachial Plexus Neuropathies - etiology Brachial Plexus Neuropathies - therapy Carbon monoxide Carbon monoxide poisoning Carbon Monoxide Poisoning - complications Carbon Monoxide Poisoning - diagnosis Carbon Monoxide Poisoning - therapy Case Report Creatine Creatine kinase Electromyography Humans Hyperbaric Oxygenation Male Nervous system diseases Neurophysiology Paralysis Treatment Outcome
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Summary:	Carbon monoxide (CO) intoxication is a leading cause of severe neuropsychological impairments. Peripheral nerve injury has rarely been reported. It consists usually in a demyelinating polyneuropathy or mononeuropathy affecting mainly the lower limbs. Isolated involvement of both upper extremities has been described in only 4 patients related to root damage. We report the first case of bilateral brachial plexus injury following CO poisoning and review all previous CO-induced neuropathy described in literature. After being unconscious for three hours, a 42 years old man experienced bilateral brachial weakness associated with edema of the face and the upper limbs. Neurological examination showed a brachial diplegia, distal vibratory, thermic and algic hypoesthesia, deep tendon areflexia in upper limbs. There was no sensory or motor deficit in lower extremities. No cognitive disturbances were detected. Creatine kinase was elevated. Electroneuromyogram patterns were compatible with the diagnosis of bilateral C5 D1 brachial axonal plexus injury predominant on the left side. Clinical course after hyperbaric oxygen therapy was marked by a complete recovery of neurological disorders. Peripheral neuropathy is an unusual complication of CO intoxication. Bilateral brachial plexus impairment is exceptional. Various mechanisms have been implicated including nerve compression secondary to rhabdomyolysis, nerve ischemia due to hypoxia and direct nerve toxicity of carbon monoxide. Prognosis is commonly excellent without any sequelae.
ISSN:	2050-6511 2050-6511
DOI:	10.1186/2050-6511-14-61