BACKGROUND Carbon monoxide poisoning is a common emergency worldwide, which carries high morbidity and mortality. Some patients who recover from the insult of acute carbon monoxide toxicity may later develop delayed neuropsychiatric sequelae (DNS) after a lucid period in the form of cognitive impairments, a broad spectrum of neurological deficits and affective disorders. Here, we present the first case of DNS following carbon monoxide poisoning in Sri Lanka and epidemiology of the exposure of nine (9) more victims. CASE PRESENTATION A 55-year-old patient and nine other people developed effects of carbon monoxide poisoning in two different occasions after sleeping few hours in the same room in their work place in Sri Lanka. These patients developed spectrum of symptoms with the acute carbon monoxide poisoning. However, one patient developed neurological deterioration pertaining to delayed neuropsychiatric sequelae (DNS) after 1 month of lucid interval. His MRI scan of the brain showed diffuse high signal intensity involving subcortical white matter, globus pallidus on FLAIR and T2W images. These areas showed high signals in DWI images with no significant changes appreciated on ADC map. There was no abnormal contrast enhancement appreciated in the above areas. EEG showed generalized slow waves. He gradually deteriorated over next 2 weeks, exhibited athetoid movements of his feet and hands and went into rigid akinetic mute state. He could not response to any stimulation and even displayed decorticated-like posture and died. Others had normal MRI brain finding at 8 weeks of acute toxicity and all were neurologically normal after 1 year. CONCLUSION Though, it is uncommon in a tropical country like Sri Lanka, clinicians should have high degree of suspicion with the correct circumstances, as it is a challenge for the emergency physicians, even in countries with higher rate of CO poisoning. The exact mechanisms of acute and delayed toxicity, preventive methods and the suggested treatments are yet to be elucidated and this needs further attention and studies.

中文翻译：

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一例一氧化碳中毒后神经系统表现延迟的病例：暴露的流行病学和文献复习。

背景技术一氧化碳中毒是世界范围内常见的紧急情况，其具有高发病率和死亡率。一些从急性一氧化碳中毒中恢复过来的患者可能会在清醒期后以认知障碍，广泛的神经功能缺损和情感障碍的形式出现延迟的神经精神后遗症（DNS）。在这里，我们介绍了斯里兰卡发生一氧化碳中毒和9（9）名更多受害人暴露的流行病学之后的DNS第一例。病例介绍一名55岁的患者和另外9个人在斯里兰卡工作场所的同一房间里睡了几个小时后，在两种不同的情况下出现了一氧化碳中毒的症状。这些患者出现急性一氧化碳中毒的症状。然而，一名患者在清醒间隔1个月后出现了与延迟神经精神后遗症（DNS）有关的神经系统恶化。他的大脑MRI扫描显示，在FLAIR和T2W图像上，弥漫性高信号强度涉及皮层下白质，苍白球。这些区域在DWI图像中显示出高信号，而ADC图上没有明显变化。在上述区域中没有发现异常的对比度增强。脑电图显示广义慢波。在接下来的两个星期中，他逐渐恶化，表现出脚和手的动脉粥样化运动，并进入僵硬的运动无声状态。他无法对任何刺激做出反应，甚至表现出脱皮的姿势而死。其他人在急性毒性的8周时MRI大脑正常，并且1年后神经学上都正常。结论 在斯里兰卡这样的热带国家，这种情况很少见，临床医生应该在正确的情况下高度怀疑，因为这对急诊医师来说是一个挑战，即使在CO中毒率较高的国家也是如此。急性和延迟毒性的确切机制，预防方法和建议的治疗方法尚待阐明，这需要进一步的关注和研究。