Diagnosis:
A combination of clinical features, MRI findings and carboxyhemoglobin testing
Clinical features:
- Symmetric Parkinson like symptoms
Findings on investigations:
MRI: bilateral globus pallidus necrosis & lesions in the putamen, patchy white matter demyelination= Grinker myelinopathy
Carboxyhemoglobin: high
Pathology:
Acute, not movement disorder: Cerebral oedema, Cherry red colour
Chronic:
- Pallidal necrosis: Bilateral, asymmetrical, gross necrosis, microscopic necrosis
- Neocortical & hippocampal necrosis can occur
- Cerebellum: loss of Purkinje cells & granlar layer
- White matter a.k.a. Grinker myelinopathy demyelination & necrosis, relative sparing of axons.