Intermittent CO poisoning has been reported to occur in 2.8% of acute CO poisoning cases and 11.8% of those who were hospitalized [10]. These two types of CO poisoning are sometimes referred to collectively as “delayed neuropsychiatric sequelae (DNS).” Iwate Medical University Hospital (“Hospital”) has an HBO chamber, and

its emergency department accepts more than 10 cases of attempted suicide with CO poisoning annually. The Hospital sometimes accepts CO poisoning cases in a very acute phase from neighboring medical institutions with no HBO chamber. Virtually all of these cases have been hospitalized after admission and have received treatment Inhibitors,research,lifescience,medical including HBO therapy, with some developing DNS and remaining having been hospitalized for prolonged periods. While it is necessary to predict the potential development of Inhibitors,research,lifescience,medical DNS at the initial stage GDC-0199 following admission to the emergency department, no correlation has been found between CO-Hb level in the blood and clinical severity [11]. It has also been found impossible to predict prognosis from EEG findings obtained at the initial stage [12]. Based on the fact that DNS is caused by demyelinating Inhibitors,research,lifescience,medical changes in the cerebral white matter, some researchers have pointed out the need to measure myelin basic protein (MBP) levels in the cerebrospinal fluid (CSF) soon after injury [13], as well as to assess nerve fibers in the white

matter by diffusion tensor imaging [14] or 1H-magnetic resonance spectroscopy [15]. However, since head MRI depicts all the various histological changes, it may not be possible to accurately tell the progress of the condition in the cerebral white matter [16]. In addition,

there Inhibitors,research,lifescience,medical have been cases who developed DNS despite having subnormal MBP levels in the CSF Inhibitors,research,lifescience,medical two weeks immediately following injury [17]. A recent study examined development of cognitive sequelae and genetic factors 6 weeks after CO poisoning. The study found that the apolipoprotein (APOE) epsilon4 allele was not associated with development of cognitive sequelae [18]. Taken together, at present no reliable means to predict DNS have been established, making prediction during the acute phase difficult. However, if the development of DNS can be predicted during the acute phase, it would help making decisions on treatment strategy, by PD184352 (CI-1040) such means as identifying cases to which HBO therapy should be actively administered and setting an appropriate period of hospital treatment. In the present study, we studied cases of attempted suicide with acute CO poisoning admitted to our emergency department, and reviewed and analyzed these cases with the intention of identifying risk factors for developing DNS and characterizing the clinical course after the development of DNS. Methods This is a retrospective cohort study of 79 consecutive patients treated at a single institution for CO poisoning.