CASE REPORT article
Front. Toxicol.
Sec. Clinical Toxicology
Cortical microstructural change linked to clinical recovery in subacute delayed encephalopathy after acute carbon monoxide poisoning: A longitudinal case report
Provisionally accepted
Takehiro Tamura*
Yuka Fujimoto
Hironobu NakamuraYuki Takahashi
Junya FujinoShunsuke TakagiHidehiko Takahashi
Genichi Sugihara- Department of Psychiatry and Behavioral Sciences, Institute of Science Tokyo, Graduate School of Medical and Dental Sciences, Bunkyo-Ku, Tokyo, Japan
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Delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) causes disabling cognitive–behavioral symptoms. While cortical atrophy is recognized as a correlate of long-term outcome, links between intracortical microstructural dynamics and clinical presentation remain largely unexplored. We followed a 51-year-old man with new-onset DEACMP for five months, using serial MRI combining cortical thickness with T1-weighted/T2-weighted (T1w/T2w) mapping as a proxy for intracortical microstructure. Despite progressive cortical thinning, T1w/T2w signals showed heterogeneous, region-specific trajectories. In the frontal networks, increases within premotor and dorsolateral prefrontal cortices aligned with improvements in executive function, whereas limited change in orbitofrontal/ventrolateral cortices was consistent with behavioral disinhibition. Overall, the clinical picture tracked more closely with intracortical signals than with morphometric atrophy. By combining T1w/T2w mapping with morphometry, this case provides the first longitudinal evidence of divergent cortical trajectories in subacute DEACMP—progressive thinning versus early intracortical improvement; confirmation in larger cohorts is warranted.
Keywords: Carbon Monoxide Poisoning, Delayed Encephalopathy after Acute Carbon Monoxide Poisoning (DEACMP), cortical microstructure, myelin mapping, cognitive impairment, Delayed encephalopathy
Received: 08 Sep 2025; Accepted: 19 Nov 2025.
Copyright: © 2025 Tamura, Fujimoto, Nakamura, Takahashi, Fujino, Takagi, Takahashi and Sugihara. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Takehiro Tamura, tamupsyc@tmd.ac.jp
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