Stroke on ECG: a cerebral T-wave change secondary to acute carbon monoxide poisoning

Stroke on ECG: a cerebral T-wave change secondary to acute carbon monoxide poisoning

Xin Xiao,MD^1,*., Xiuna Jing,MD^2,*., Yun Zhao,MD^3,*., Fei Yao,MD^4,*., Qing Sun, MD^5.

Dept. of the Military and Special Medicine, No.971 Hospital of the PLA Navy, Qingdao,266071, China

Running title: a cerebral T-wave change secondary to acute carbon monoxide poisoning

Funding:medical and health development project of Shandong province (202212010474)

Stroke on ECG: a cerebral T-wave change secondary to acute carbon monoxide poisoning

CEREBRAL T-WAVE CHANGE SECONDARY TO ACUTE CO POISONING

ABSTRACT

In clinical management of carbon monoxide (CO) poisoning, serum cardiac enzyme biomarkers and electrocardiogram (ECG) are both highly recommended emergency check-ups to evaluate myocardial injuries. Medical imaging – including head CT or MRI – are not routine for CO poisoning emergency management. We herein report on a comatose patient who was diagnosed with cerebral infarction secondary to 24 hours previous acute CO poisoning, warned by a typical cerebral-type T waves on ECG in advance, and confirmed by a head MRI. Fortunately, the patient made a full recovery based on a timely treatment with medications and hyperbaric oxygen (HBO2) therapy. We would like to propose that a vital, stable, conscious CO poisoning patient who remains a higher risk for hemorrhagic or ischemic stroke should be closely monitored for potential neurological abnormalities, and a continuous ECG monitoring should be reinforced throughout the treatment. A head MRI or CT is a priority in evaluating the secondary cerebral stroke and should be arranged immediately in the event of an abnormal ECG or if unusual new symptoms are apparent.

Keywords

carbon monoxide poisoning; cerebral infarction; cerebral T-wave; magnetic resonance imaging (MRI)

Key points

1. A vital stable, conscious CO poisoning patient who remains a higher risk for hemorrhagic or ischemic stroke should be closely monitored for potential neurological abnormalities, and a continuous ECG monitoring should be reinforced throughout the treatment. 

2. A head MRI or CT is critical in evaluating the secondary cerebral stroke and should be arranged immediately in the event of an abnormal ECG or if unusual new symptoms rare apparent.

DOI:10.22462/630