Abstract
Purpose To describe the electrophysiological and psychophysical effects of carbon monoxide (CO) poisoning on visual function.
Methods Three patients are presented who suffered CO poisoning, two due to suicide attempts and one in the course of a road traffic accident. After a full ocular examination, Goldmann visual fields, flash and pattern visual evoked potentials (VEPs) and flash and pattern electroretinograms (ERGs) were tested.
Results Electrophysiology showed reduced or absent N95 components of the pattern ERG and delayed, reduced VEPs. A positive-negative-positive (PNP) VEP waveform was seen in two cases. In one case, where presentation occurred at an early stage, visual and electrophysiological function was improved with hydroxycobalamine.
Conclusions The combination of ERG and VEP findings suggest that CO poisoning can cause a toxic optic neuropathy that may have a similar aetiological mechanism to that in tobacco amblyopia. Early treatment with hydroxycobalamine may be of some benefit.
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Silverman IE, Galetta SL, Gray LG, Moster M, Atlas SW, Maurer, AH, Alavi A . SPECT in patients with cortical visual loss. J Nucl Med 1993;34:1447–51.
Quattrocolo G, Leotta D, Appendino L, Tarenzi L, Duca S . A case of cortical blindness due to carbon monoxide poisoning. Ital J Neurol Sci 1987;8:57–8.
Katafuchi Y, Nishimi T, Matsuishi T, Kimura Y, Otaki E, Yamashita Y . Cortical blindness in acute carbon monoxide poisoning. Brain Dev 1985;7:516–9.
Sparr SA, Jay M, Drislane FW, Venna N . A historic case of visual agnosia revisited after 40 cases. Brain 1991;114:789–800.
Vieregge P, Klosterman W, Blumm RG, Borgis KJ . Carbon monoxide poisoning: clinical, neurophysiological and brain imaging observations in acute disease and follow up. J Neurol 1989;236:478–81.
Zagami AS, Lethlean AK, Mellick R . Delayed neurological deterioration following carbon monoxide poisoning. J Neurol 1993;240:113–6.
Oku H, Fukushima K, Miyata M, Wakakura M, Ishikawa S . Cyanide with vitamin B12 deficiency as the cause of experimental tobacco amblyopia [English abstract]. Nippon Ganka Gakkai Zasshi 1991;95:158–64.
He F, Liu X, Yang S, Xu G, Fang G, Fan X . Evaluation of brain function in acute carbon monoxide poisoning with multimodality evoked potentials. Environ Res 1993;60:213–26.
Arezzo JC, Simson R, Brennan NE . Evoked potentials in the assessment of neurotoxicity in humans. Neurobehav Toxicol Teratol 1985;7:299–304.
Marmor MF, Arden GB, Nilsson SEG, Zrenner E . Standard for clinical electroretinography: International Standardisation Committee. Arch Ophthalmol 1989;107:816–9.
Marmor MF, Holder GE, Porciatti V, Trick GL, Zrenner E . Guidelines for basic pattern electroretinography. Doc Ophthalmol 1996;91:291–8.
Holder GE . Delayed VEPs: retinal or optic nerve disease? Electroencephalogr Clin Neurophysiol 1988;96:72–3.
Halliday AM . Visually evoked responses in optic nerve disease. Trans Ophthalmol Soc UK 1976;96:372–6.
Kriss A, Carroll WM, Blumhardt LD, Halliday AM . Pattern and flash evoked potentials in toxic (nutritional) optic neuropathy. In: Courjon J, Maugiere F, Revol M, editors. Clinical applications of evoked potentials in neurology. New York: Raven Press, 1982:11–9.
Harding GFA, Crews SJ, Good PA . VEP in neuro-ophthalmic disease. In: Barber C, editor. Evoked potentials. Lancaster: MTP Press, 1980:235–41.
Berringer TA, Jaeger W, Krastel A . Electrophysiology and colour perimetry in dominant infantile optic atrophy. Br J Ophthalmol 1991;75:49–52.
Berringer TA, Bird AC, Arden GB . Leber's hereditary optic atrophy. Ophthalmic Paediatr Genet 1989;10:211–27.
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Simmons, I., Good, P. Carbon monoxide poisoning causes optic neuropathy. Eye 12, 809–814 (1998). https://doi.org/10.1038/eye.1998.209
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DOI: https://doi.org/10.1038/eye.1998.209
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