Apoptotic and necrotic brain lesions in a fatal case of carbon monoxide poisoning

A 41-year-old man was accidentally exposed to carbon monoxide (CO) gas and found in a state of cardiopulmonary arrest while he took bath. After admiss ion, he was resuscitated and underwent artificial ventilation in a comatose state and died about 19 h later Computed tomography (CT) examination discl osed bilateral low density area in the basal ganglia and the thalamus, a we ll-known finding in the CO intoxication. Necropsy, histological examination , DNA ladder assay gave the first line of evidence for the presence of apop tosis as well as necrosis in the human case of CO intoxication. TdT-mediate d dUTP-biotin nick-end labeling (TUNEL) positive apoptotic cells were more predominant in the CA2 area than in CAI area. There is general co-relation between the ratio of TUNEL-positive cells and the DNA laddering on the agar ose gel. Basal ganglia and thalamus, which showed bilateral low density are a in CT, were revealed to be severe edema. The two types of cell death occu rred in the cortex, basal ganglia, hippocampus, thalamus, and cerebellum. H ypoxia caused by GO-hemoglobin formation alone cannot explain the phenomena . (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.