Detecting the Undetectable: A Case Series on Carbon Monoxide Poisoning and Diagnostic MRI Utility

Abstract

Background: Carbon monoxide is a colorless, odorless asphyxiant that can produce a wide range of clinical manifestations, from mild, flu-like symptoms to life-threatening complications such as respiratory failure, coma and death. Diagnosis can be challenging in the absence of a clear exposure history.

Case Presentation: We describe a case series of three young male laborers who presented to the emergency department with acute altered mental status and no initial identifiable cause. Routine investigations, including CT brain imaging and toxicology screening were unremarkable. Subsequent history revealed possible exposure to a wood-burning heater in a closed room. Carboxyhemoglobin levels were elevated in one of the patient. MRI brain performed in one patient demonstrated bilateral globus pallidus hyperintensities, consistent with carbon monoxide toxicity. All patients improved with high-flow oxygen therapy.

Conclusion: Carbon monoxide poisoning should be considered in patients presenting with unexplained acute delirium, particularly when environmental exposure is possible but not initially apparent. MRI can serve as a valuable diagnostic tool when clinical suspicion is high, even in the absence of an obvious exposure history.