Neuron-speciﬁc Enolase Level after the Onset of Delayed Neurological Sequelae with Acute Carbon Monoxide Intoxication
1Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
DOI: 10.22514/sv.2020.16.0042 Vol.17,Issue 1,January 2021 pp.200-204
Published: 08 January 2021
Background: Delayed neurological sequelae (DNS) is a major problem in carbon monoxide (CO) intoxication. Many other studies have showed whether serum NSE of acute phase can predict DNS in CO poisoning. However, no study has examined NSE levels after development of DNS. Therefore, we report serum NSE levels after the onset of DNS. Case presentation: We described the NSE levels in two cases of DNS. The first was a 33-year-old woman who presented with concentration problems 39 days after CO exposure. The second was a 51-year-old woman who presented with gait disturbance and urinary incontinence 23 days after CO exposure. Brain magnetic resonance imaging (MRI) and NSE levels were obtained in both patients. Brain MRI confirmed brain injury and the diagnosis of DNS was made. The NSE levels of the two patients were 12.51 and 16.18 ng/mL, respectively. Conclusion: Although the initial NSE elevated level may be useful in the prediction of carbon monoxide induced DNS, it may be decreased to normal reference range after the onset of DNS.
Brain injury, Carbon monoxide, Complications, Poisoning, Neuron specific enolase
Sangsoo Han,Sangun Nah,Sungwoo Choi,Young Hwan Lee. Neuron-speciﬁc Enolase Level after the Onset of Delayed Neurological Sequelae with Acute Carbon Monoxide Intoxication. Signa Vitae. 2021. 17(1);200-204.
 Thom SR, Taber RL, Mendiguren II, et al. Delayed neuropsychologic sequelae after carbon monoxide poisoning: prevention by treatment with hyperbaric oxygen. Ann Emerg Med. 1995;25:474–480.
 Thom SR, Bhopale VM, Fisher D, et al. Delayed neuropathology after carbon monoxide poisoning is immune-mediated. Proc Natl Acad Sci U S A. 2004;101:13660–13665.
 Norris JC, Trench J, Hook R. Delayed carbon monoxide encephalopathy: clinical and research implications. J Clin Psychiatry. 1982;43:294-295.
 Pan K-T, Shen C-H, Lin F-G, et al. Prognostic factors of carbon monoxide poisoning in Taiwan: a retrospective observational study. BMJ open. 2019;9:e031135.
 Annane D, Chevret S, Jars-Guincestre M, et al. Prognostic factors in unintentional mild carbon monoxide poisoning. Intensive Care Med. 2001;27:1776-1781.
 Cha Y, Kim H, Do H, et al. Serum neuron-specific enolase as an early predictor of delayed neuropsychiatric sequelae in patients with acute carbon monoxide poisoning. Hum Exp Toxicol. 2018;37:240–246.
 P E Vos, K J B Lamers, J C M Hendriks, et al. Glial and neuronal proteins in serum predict outcome after severe traumatic brain injury. Neurology. 2004;62:1303–1310.
 Wiberg S, Hassager C, Stammet P, et al. Single versus serial measure-ments of neuron-specific enolase and prediction of poor neurological outcome in persistently unconscious patients after out-of-hospital cardiac arrest–a TTM-trial substudy. PLoS One. 2017;12:e0168894.
 Zaheer S, Beg M, Rizvi I, et al. Correlation between serum neuron specific enolase and functional neurological outcome in patients of acute ischemic stroke. Ann Indian Acad Neurol. 2013;16:504.
 Meynaar IA, Oudemans-van Straaten HM, van der Wetering J, et al. Serum neuron-specific enolase predicts outcome in post-anoxic coma: a prospective cohort study. Intensive Care Med. 2003;29:189-195.
 Cakir Z, Aslan S, Umudum Z, et al. S-100β and neuron-specific enolase levels in carbon monoxide–related brain injury. Am J Emerg Med. 2010;28:61–67.
 Weaver LK, Hopkins RO, Chan KJ, et al. Hyperbaric oxygen for acute carbon monoxide poisoning. N Engl J Med. 2002;347:1057–1067.
 Rosen H, Sunnerhagen KS, Herlitz J, et al. Serum levels of the brain-derived proteins S-100 and NSE predict long-term outcome after cardiac arrest. Resuscitation. 2001;49:183–191.
 Gilmer B, Kilkenny J, Tomaszewski C, et al. Hyperbaric oxygen does not prevent neurologic sequelae after carbon monoxide poisoning. Acad Emerg Med. 2002;9:1–8.
 Moon J, Chun B, Lee S, Jung E. Serum neuron-specific enolase levels at presentation and long-term neurological sequelae after acute charcoal burning-induced carbon monoxide poisoning. Clin Toxicol. 2018;56:751-758.
 Jung JW, Lee JH. Serum lactate as a predictor of neurologic outcome in ED patients with acute carbon monoxide poisoning. Am J Emerg Med. 2019;37:823-827.
 Jurič DM, Finderle Ž, Šuput D, et al. The effectiveness of oxygen therapy in carbon monoxide poisoning is pressure- and time-dependent: a study on cultured astrocytes. Toxicol Lett. 2015;233:16–23.
 Gilmer B, Kilkenny J, Tomaszewski C, et al. Hyperbaric oxygen does not prevent neurologic sequelae after carbon monoxide poisoning. Acad Emerg Med. 2002;9:1-8.
Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.
Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.
Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.
IndexCopernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.
Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.
Scopus Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.
Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.