Objective: To improve the knowledge of carbon monoxide (CO) encephalopathy among the masses and medical staff in rural areas and coal-burning areas.

Methods: The clinical diagnosis and treatment of one elderly male patient with severe CO encephalopathy were described, and the clinical features, diagnosis, treatment and prognosis of this patient were summarized.

Results: The main clinical manifestations of this patient with severe CO encephalopathy were paralysis, cognitive decline and secondary epilepsy. After the treatment of integrated traditional Chinese and western medicine and rehabilitation training, the patient’s paralysis and cognitive ability gradually improved, and there was no epileptic seizure.

Conclusion: CO encephalopathy is a kind of delayed encephalopathy after acute CO poisoning. When treating patients with acute CO poisoning, the risk of neurological sequelae must be considered and effective intervention measures should be given as soon as possible to improve the prognosis.