Delayed encephalopathy after
carbon monoxide poisoning can bepredicted by acute symptom
65th Annual Meeting of the Japanese Society of Neurology, 2024

静岡済生会総合病院○鈴木康弘 狩野允芳 兒島辰哉

一酸化炭素中毒の急性期重症度と遅発性脳症発症の関係

Abstract• To predict delayed neurological sequelae (DNS), themost useful subtest in WAIS (-III and –IV) was block
design.
• Likewise, the most useful IQ or index wasperformance IQ in WAIS-III.
ROC曲線下面積（AUC）を指標にすると、遅発性脳症発症の予測に最も有用な、WAIS-III,－IVに共通な下位検査は「積木」だった。

同様にAUCを指標にすると、複合的「指標」の中でもっとも有用なのは動作性IQだった。

Objectives• Last year, we presented the relationship between
delayed CO encephalopathy and acute symptom(CK value and period unable to walk).
• This year, we present the relationship between
occurrence of delayed CO encephalopathy andcognitive function in intermittent period.

我々は、昨年に引き続き、一酸化炭素中毒の遅発性脳症が、急性期に予測可能かを検討した。

Methods• Retrospective research• Twenty-nine patients of CO intoxication underwent WAIS
• Patients were followed for 6 weeks to check occurrence of DNS.
• Four patients developed Delayed Neurological Sequelae (DNS) at days
17, 18, 30, and 41 after CO exposure.
• Days of cognitive examination from CO exposure: IQR 6-12; mean 11.4;
median 9• Subtests and Indexes with large AUC are shown.
• Number of HBO sessions are added in bivariate analysis.

CO中毒29例で暴露後約10日後にWAIS を施行し、成績とその後の遅発性脳症発症の関係を調べた。

Results
Subtests which were related to occurrence of DNS
SubtestThreshold(Youden)sensitivity

specificity

AUC

理解

Comprehension

810.670.83

Excluded from WAIS
IV, verbal test

組み合わせ

Object assembly

610.80.83

Excluded from WAIS
IV積木Block design

5.5

10.82

0.82

絵画配列

Picturearrangement

810.570.80

行列

Matrix reasoning

9.5

10.50.76

符号

Digit symbol

4.50.750.770.73

Excluded from WAIS
IV

遅発性脳症発症と関係が深いWAISの下位検査

Block Design

Matrix Reasoning○ recover ●delayed encephalopathy

ー discriminating line by two variate logistic regression

10846

Test score

1025

Test score1512---threshold by Youden method

0510152025

Number of HBO sessions

0510152025

Number of HBO sessions「積木」「行列」はWAIS-IVにも採用された検査でもっとも有用Comprehension

Object assembly

10846Test score

1086224

Test score

12 14

12○ recover ●delayed encephalopathy---threshold by Youden method ー discriminating line by two variate logistic regression

0510152025

Number of HBO sessions

05

10152025

Number of HBO sessions

WAIS-IVのコアテストから除かれた「理解」「組み合わせ」も有用

Index scale which were related
to occurrence of DNS
Index

Threshold sensitivity specificity(Youden)

AUC

動作性IQ Performance 67.5
IQ

10.84

0.84

知覚統合

Perceptual86
organization

10.630.78

全IQ

Full IQ

89.5

10.560.77

言語性IQ Verbal IQ

91.5

10.56

0.76

処理速度

77.5

10.440.67

Processing
speed

Excluded from
WAIS IV

Excluded from
WAIS IV

遅発性脳症発症と関係が深いWAISの指標

Performance IQ

Verbal IQ○ recover ●delayed encephalopathy

90 1007080

Test score

100806060

Test score

120---threshold by Youden method ー discriminating line by two variate logistic regression

05101520

Number of HBO sessions

2505101520

Number of HBO sessions「指標」のうちでは「動作性IQ」がもっとも有用25

Full scale IQ

Perceptual Organization

1006080

Test score

50 60 70 80 90

Test score

110

120

○ recover ●delayed encephalopathy---threshold by Youden method ー discriminating line by two variate logistic regression

05101520

Number of HBO sessions

250510152025

Number of HBO sessions

WAIS-III以後の「指標」のうちでは「知覚統合」が有用

Cognitive tests other than WAIS

かなひろい
三宅

Test

Threshold(Youden)sensitivity specificity

AUC

Kana pickup

16.5

0.86

0.73

0.79

10.58

0.76

無関係 Miyake non- 3.5
associated

ミニメンタル MMSE

26.5

0.71

0.77

0.73

改訂長谷川

220.55

0.86

0.72

140.5

0.83

0.69

三宅HDS-R

有関係 Miyake
associatedMiyake’s non-associated word pair test
(Total score of three times)

20
15510Test score3020
1000Test score

402550Kana pick-up test

0510152025

Number of HBO sessions

0510152025

Number of HBO sessions「かなひろいテスト」「三宅式無関係対語」は有用

MMSE(n=33)

0

5

1015

2025

Number of HBO sessions

25
1015

20

Test score201510Test score

2530

30

Hasegawa Dementia Scale-R(n=40)

0

5

1015

2025

Number of HBO sessions「改定長谷川」「MMSE」はあまり役に立たない。

Conclusions• The most predictive subtest was “block design.”• The most predictive index was “Performance IQ.”
• WAIS-III was more predictive than WAIS-IV inthat “performance IQ” was measurable.
WAIS-IIIからIVへの改変は、DNSの予測という見地からはむしろ改悪かも。
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