CHRONIC CARBON MONOXIDE POISONING PRESENTING AS NEW DAILY PERSISTENT HEADACHE: A CASE REPORT AND REVIEW OF THE LITERATURE

Objectives: To sensitize the paediatric neurology community to the presentation of chronic carbon monoxide poisoning.

Methods: A case report demonstrating the clinical presentation of chronic CO poisoning, a review of the literature and indications for treatment with hyperbaric oxygen therapy (HBO) in the paediatric population.

Results: A 15 year old girl presented with a history a sudden onset persistent headache for 4 weeks associated with dizziness, fatigue, sleeplessness, auditory and visual hallucinations and abdominal pain. She complained of concentration and memory difficulties. She had an unremarkable physical and neurological examination. MRI, EEG were normal but investigation found an elevated carboxyhemoglobin level. Assessment of the household was positive for a gas leak of unknown duration, with direct exposure to the individual. Neuropsychological evaluation was performed followed by treatment with hyperbaric oxygen therapy. The results are discussed. Conclusion: Chronic low-dose carbon monoxide (CO) exposure can present insidiously with symptoms that are frequently neuropsychiatric in nature. In adults, chronic CO poisoning is often misdiagnosed for flu like or psychological illnesses. The current literature is reviewed. Some studies have shown the use of neuropsychological evaluation to demonstrate the effect of a toxic exposure. The efficacy of treatment with hyperbaric oxygen therapy is controversial and is discussed. A high level of clinical suspicion is needed to make the diagnosis.