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A 33 Year Old Woman Was Found Unconscious At Her House

She Had Been Exposed To Carbon Monoxide From A Faulty Heater

Doctors Admitted Her To An Intensive Care Unit

Severe Neurological Symptoms Led Them To Intubate And Sedate Her

On The 15th Day After Admission She Began Following Commands

Doctors Then Weaned Her Off The Ventilator

She Moved To A Rehabilitation Unit On The 18th Day

Her Disability Rating Scale Score Was 8 Out Of 30

That Score Corresponds To Moderately Severe Disability

At First She Showed Good Adherence To Rehabilitation

The Authors Call The Time Before Her Decline A Lucid Interval

About 40 Days After The Exposure She Became Confused

Her Movement And Thinking Slowed Down

Short Term Memory And Sustained Attention Were Impaired

Her Disability Score Then Rose To 16 Out Of 30

The Authors Called That Severe Disability

She Could No Longer Hold An Upright Position

Treatment Included 40 Sessions Of Hyperbaric Oxygen Therapy

Her Drugs Included N Acetylcysteine And Glucocorticoids

Complete Motor Recovery Was Observed Within 150 Days

Her Disability Score Later Improved To 3 Out Of 30

That Meant A Partial Residual Disability

At 18 Months Her Thinking Tests Were All Within Normal Range

The Authors Say A Spontaneous Recovery Cannot Be Ruled Out

One Woman's Case Cannot Show How Often This Happens

Three Papers Give Three Different Ranges

Her Case Report Calls The Damage Delayed Neurological Sequelae

That Term Means Brain And Mental Problems That Appear Later

The Authors Say A Significant Number Of Survivors Develop Them

Reported Rates Run From 3 To 40 Percent

The Authors Cite The Lack Of Established Diagnostic Criteria

A Second Paper Says About 3 Percent With A Range Of 0.2 To 40

Delayed Symptoms Are More Frequent In Elderly Patients

Patients After A Prolonged Coma Show Them More Often Too

That Paper Puts The Coma At 12 To 48 Hours

A Third Paper Estimates Delayed Effects In 1 To 47 Percent

None Of The Three Papers Gives The Same Range

Her Case Report And The Others Disagree On When It Starts

Its Authors Put The Typical Start At 27 To 270 Days After Injury

The Second Paper Has 2 To 40 Days Of Seeming Recovery First

On Average That Lasts Three Weeks

The Third Paper Requires The Same 2 To 40 Days For Diagnosis

The Third Paper Calls The Delayed Damage Recurrent And Transient

Periods Of Worsening Alternate With Periods Of Remission

That Paper Describes A 48 Year Old Man

He Had Fainted After Carbon Monoxide Exposure A Month Earlier

Another Hospital Admitted Him To Intensive Care

He Had Three Sessions Of Hyperbaric Oxygen Treatment

Doctors Discharged Him Without Sequelae

Later He Came To The Emergency Department With Loss Of Balance

He Also Had Trouble Walking And Urinary Incontinence

The Trouble Had Lasted One Week

Doctors Diagnosed Delayed Damage From The Poisoning

Hyperbaric Oxygen Therapy Was Planned

The Second Paper Lists What A Delayed Decline Can Include

After The Seeming Recovery Rapid Deterioration Develops

Memory Disturbances And Disorientation Are On Its List

So Are Reduced Movement And Urinary Incontinence

Psychotic Behaviour And Personality Changes Are Included

Apathy And Anxiety Appear On The List As Well

The Third Paper Says Most Poisoned Patients Recover With Oxygen

A Minority Have Lasting Problems Or Delayed Brain Disease