A Case of Cerebral Infarction Provoked by Carbon Monoxide A Case of Cerebral Infarction Provoked by Carbon Monoxide Poisoning in Probable Unilateral Moyamoya Disease

CASE REPORT

J Neurocrit Care 2009;2(2): 56-59.

Sang-Moo Lee, MD, PhD, Heui-Chul Choi, MD, PhD and Jong-Hee Sohn, MD

Department of Neurology, Hallym University College of Medicine, Chuncheon Sacred Heart Hospital, Chuncheon, Korea

ABSTRACT

Background: Hemodynamic reserve is known to be reduced in moyamoya disease, which could account for increased susceptibility to cerebral ischemia. We report a case of acute cerebral infarction provoked by carbon monoxide (CO) poisoning in probable unilateral moyamoya disease.
Case Report: A 26-year-old woman presented with mental changes followed by left hemiparesis after an exposure to CO. The initial serum carboxyhemoglobin level was 25.2%. She was alert but showed clinical signs of diffuse right hemispheric dysfunction. Brain MRI showed large territorial infarction in the right middle cerebral artery (MCA) and anterior cerebral artery (ACA). Brain MRA and conventional angiogram demonstrated complete occlusion of the proximal part of the right MCA and the ACA, which was suggestive of probable unilateral moyamoya disease.
Conclusions: It was likely that cerebral hypoxia induced by CO poisoning produced acute cerebral infarction in a hemodynamically compromised state.

Key Words: Moyamoya disease·Cerebral infarction·Carbon monoxide poisoning