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Neuron-specific Enolase Level after the Onset of Delayed Neurological Sequelae with Acute Carbon Monoxide Intoxication

  • Sangsoo Han1
  • Sangun Nah1
  • Sungwoo Choi1
  • Young Hwan Lee1

1Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea

DOI: 10.22514/sv.2020.16.0042 Vol.17,Issue 1,January 2021 pp.200-204

Published: 08 January 2021

*Corresponding Author(s): Young Hwan Lee E-mail:


Background: Delayed neurological sequelae (DNS) is a major problem in carbon monoxide (CO) intoxication. Many other studies have showed whether serum NSE of acute phase can predict DNS in CO poisoning. However, no study has examined NSE levels after development of DNS. Therefore, we report serum NSE levels after the onset of DNS. Case presentation: We described the NSE levels in two cases of DNS. The first was a 33-year-old woman who presented with concentration problems 39 days after CO exposure. The second was a 51-year-old woman who presented with gait disturbance and urinary incontinence 23 days after CO exposure. Brain magnetic resonance imaging (MRI) and NSE levels were obtained in both patients. Brain MRI confirmed brain injury and the diagnosis of DNS was made. The NSE levels of the two patients were 12.51 and 16.18 ng/mL, respectively. Conclusion: Although the initial NSE elevated level may be useful in the prediction of carbon monoxide induced DNS, it may be decreased to normal reference range after the onset of DNS.


Brain injury, Carbon monoxide, Complications, Poisoning, Neuron specific enolase

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Sangsoo Han,Sangun Nah,Sungwoo Choi,Young Hwan Lee. Neuron-specific Enolase Level after the Onset of Delayed Neurological Sequelae with Acute Carbon Monoxide Intoxication. SignaVitae. 2021. 17(1);200-204.


[1] Thom SR, Taber RL, Mendiguren II, et al. Delayed neuropsychologic sequelae after carbon monoxide poisoning: prevention by treatment with hyperbaric oxygen. Ann Emerg Med. 1995;25:474–480.

[2] Thom SR, Bhopale VM, Fisher D, et al. Delayed neuropathology after carbon monoxide poisoning is immune-mediated. Proc Natl Acad Sci U S A. 2004;101:13660–13665.

[3] Norris JC, Trench J, Hook R. Delayed carbon monoxide encephalopathy: clinical and research implications. J Clin Psychiatry. 1982;43:294-295.

[4] Pan K-T, Shen C-H, Lin F-G, et al. Prognostic factors of carbon monoxide poisoning in Taiwan: a retrospective observational study. BMJ open. 2019;9:e031135.

[5] Annane D, Chevret S, Jars-Guincestre M, et al. Prognostic factors in unintentional mild carbon monoxide poisoning. Intensive Care Med. 2001;27:1776-1781.

[6] Cha Y, Kim H, Do H, et al. Serum neuron-specific enolase as an early predictor of delayed neuropsychiatric sequelae in patients with acute carbon monoxide poisoning. Hum Exp Toxicol. 2018;37:240–246.

[7] P E Vos, K J B Lamers, J C M Hendriks, et al. Glial and neuronal proteins in serum predict outcome after severe traumatic brain injury. Neurology. 2004;62:1303–1310.

[8] Wiberg S, Hassager C, Stammet P, et al. Single versus serial measure-ments of neuron-specific enolase and prediction of poor neurological outcome in persistently unconscious patients after out-of-hospital cardiac arrest–a TTM-trial substudy. PLoS One. 2017;12:e0168894.

[9] Zaheer S, Beg M, Rizvi I, et al. Correlation between serum neuron specific enolase and functional neurological outcome in patients of acute ischemic stroke. Ann Indian Acad Neurol. 2013;16:504.

[10] Meynaar IA, Oudemans-van Straaten HM, van der Wetering J, et al. Serum neuron-specific enolase predicts outcome in post-anoxic coma: a prospective cohort study. Intensive Care Med. 2003;29:189-195.

[11] Cakir Z, Aslan S, Umudum Z, et al. S-100β and neuron-specific enolase levels in carbon monoxide–related brain injury. Am J Emerg Med. 2010;28:61–67.

[12] Weaver LK, Hopkins RO, Chan KJ, et al. Hyperbaric oxygen for acute carbon monoxide poisoning. N Engl J Med. 2002;347:1057–1067.

[13] Rosen H, Sunnerhagen KS, Herlitz J, et al. Serum levels of the brain-derived proteins S-100 and NSE predict long-term outcome after cardiac arrest. Resuscitation. 2001;49:183–191.

[14] Gilmer B, Kilkenny J, Tomaszewski C, et al. Hyperbaric oxygen does not prevent neurologic sequelae after carbon monoxide poisoning. Acad Emerg Med. 2002;9:1–8.

[15] Moon J, Chun B, Lee S, Jung E. Serum neuron-specific enolase levels at presentation and long-term neurological sequelae after acute charcoal burning-induced carbon monoxide poisoning. Clin Toxicol. 2018;56:751-758.

[16] Jung JW, Lee JH. Serum lactate as a predictor of neurologic outcome in ED patients with acute carbon monoxide poisoning. Am J Emerg Med. 2019;37:823-827.

[17] Jurič DM, Finderle Ž, Šuput D, et al. The effectiveness of oxygen therapy in carbon monoxide poisoning is pressure- and time-dependent: a study on cultured astrocytes. Toxicol Lett. 2015;233:16–23.

[18] Gilmer B, Kilkenny J, Tomaszewski C, et al. Hyperbaric oxygen does not prevent neurologic sequelae after carbon monoxide poisoning. Acad Emerg Med. 2002;9:1-8.

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