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LETTER TO EDITOR
Year : 2021  |  Volume : 69  |  Issue : 3  |  Page : 772-773

A Case of Gas Geyser Syndrome with Peculiar Findings on MRI Brain


1 Department of Neurology, Bombay Hospital Institute of Medical Sciences, New Marine Lines, Mumbai, Maharashtra, India
2 Department of Radiology, Bombay Hospital Institute of Medical Sciences, New Marine Lines, Mumbai, Maharashtra, India

Date of Submission17-Nov-2017
Date of Decision01-Apr-2018
Date of Acceptance12-Jun-2020
Date of Web Publication24-Jun-2021

Correspondence Address:
Dr. Varsha A Patil
Room No 215, Second Floor, New Wing, Bombay Hospital Institute of Medical Sciences, New Marine Lines, Mumbai - 400 020, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.319197

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How to cite this article:
Patil VA, Lovhale NS, Jaggi ST, Tandel SV. A Case of Gas Geyser Syndrome with Peculiar Findings on MRI Brain. Neurol India 2021;69:772-3

How to cite this URL:
Patil VA, Lovhale NS, Jaggi ST, Tandel SV. A Case of Gas Geyser Syndrome with Peculiar Findings on MRI Brain. Neurol India [serial online] 2021 [cited 2021 Jul 28];69:772-3. Available from: https://www.neurologyindia.com/text.asp?2021/69/3/772/319197




Sir,

Neurological syndromes due to acute carbon monoxide toxicity, arising from the use of gas geysers, have been described in India.[1]

The typical findings seen on magnetic resonance imaging (MRI) of brain in gas geyser syndrome are bilateral symmetrical hyperintensities in globi pallidi and white matter lesions, especially in the periventricular region.[2] We report a case with peculiar neuroimaging findings, not frequently described.

A 31-year-old healthy lady went for a trip to a hill station. After going for a bath, she didn't come out for an hour. On forcibly opening the door of the bathroom, she was found unconscious on the floor without any tonic movements of the limbs or frothing at mouth. The entire bathroom was full of toxic fumes. She was rushed to a nearby hospital and given oxygen therapy and intravenous fluids. She regained consciousness within half an hour. A week later, she presented to us with complaints of acute onset memory disturbances, blurring of vision, and headache for four days. She had complete amnesia of the event.

On physical examination, her vitals were stable. She had both anterograde and retrograde amnesia. Her visual acuity was affected (left eye- 6/60, right eye- 6/36; near vision- N18 bilaterally). Color vision was significantly impaired in both eyes. Fundus examination revealed bilateral temporal disc pallor. The remainder of her general and systemic examination was normal.

Her routine blood investigations (including hemogram, liver, and renal function tests) were normal. MRI Brain [Figure 1] revealed symmetrical signal abnormality in bilateral occipital cortices, hippocampi, and cerebellar cortex. These areas were hyperintense on T2W and FLAIR images and showed restricted diffusion and mild patchy post contrast enhancement. MR Angiography was normal.
Figure 1: Magnetic resonance imaging (MRI) study revealed symmetrical signal abnormality in bilateral occipital cortices, hippocampi and cerebellar cortex, which were hyperintense on T2-weighted and FLAIR images (a-c) and showed restricted diffusion (d-f)

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Her headache gradually subsided, however, memory disturbances persisted. Visual acuity improved to 6/18 in both eyes and color vision improved significantly over next five days. In retrospect, we found that the hotel where she had checked in used gas geysers. We postulate that her clinical syndrome was due to acute carbon monoxide toxicity.

Very often, such cases present to the emergency room with sudden unconscious state.[1] Various other symptoms including rarely a delayed onset of neuropsychiatric symptoms are described. Visual impairment, which may be transient, with normal to near normal recovery has been noted in both children and elderly patients.[3]

Besides the typical changes described in the globi pallidi, demyelination and hemorrhage (affecting cerebral cortex as well as subcortical white matter), cerebral atrophy and focal structural lesions are described.[4] The temporal lobe and hippocampus are more commonly affected than the cerebral cortex.[3]

In our case, the typical changes in the basal ganglia were not seen. This probably emphasizes the fact that various mechanisms of toxicity exist. Affection of different areas of the brain is duration dependent, and certain areas like hippocampus are also equally predisposed to the basal ganglia.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Correia P, Agrawal C, Ranjan R. Gas geyser syndrome: An important preventable cause of disabling neurological events. Ann Indian Acad Neurol 2013;16:245-8.  Back to cited text no. 1
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2.
Lo CP, Chen SY, Lee KW, Chen WL, Chen CY, Hsueh CJ, et al. Brain injury after acute carbon monoxide poisoning: Early and late complications. AJR Am J Roentgenol 2007;189:205-11.  Back to cited text no. 2
    
3.
Kara H, Bayir A, Ak A, Degirmenci S. Cerebrovascular ischaemia after carbon monoxide intoxication. Singapore Med J 2015;56:e26-8.  Back to cited text no. 3
    
4.
Chang YT, Chang WN, Huang SH, Lui CC, Lee CC, Chen NC, et al. Neuroimaging studies in carbon monoxide intoxication. In: Prof. Bright P, editor. Neuroimaging-Cognitive and Clinical Neuroscience. InTech; 2012.  Back to cited text no. 4
    


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