Abstract
We report a case of postanoxic leukoencephalopathy in a patient who started to have cognitive and behavioral changes weeks after the anoxic insult along with white matter lesions on neuroimaging and demyelination on brain biopsy. His disease course followed a steady decline initially both clinically and radiologically and assumed a steady plateau. Months after his decline, the patient was seen to be completely functional with substantially improved mental status examination and resolution of white matter changes on imaging. The course of this disease entity usually assumes a plateau after clinical worsening with little improvement subsequently. However, our patient showed a dramatic recovery to his baseline after a few months. In this article, we review mechanisms, presentation and the sequelae of hypoxic injury to the brain.
Highlights
Categories: Neurology Keywords: anoxic encephalopathy, white matter changes, demyelination, leukocyte arylsulfatase a Delayed hypoxic reversible leukoencephalopathy syndrome (DHRLS) is a rare entity characterized by neurological relapse after initial recovery following an acute hypoxic insult
Prolonged hypoxia leads to impaired oxygen delivery which causes disruption of enzymatic pathways involved in myelin turnover, resulting in delayed demyelination
One month prior to his presentation, he underwent cardiopulmonary resuscitation (CPR) when he was found unresponsive at his home
Summary
Delayed hypoxic reversible leukoencephalopathy syndrome (DHRLS) is a rare entity characterized by neurological relapse after initial recovery following an acute hypoxic insult. During the course of hospitalization, the patient showed gradual deterioration in his mental faculties. He underwent two magnetic resonance imaging (MRI) studies – first one during the initial admission and the second one, 10 days later. The initial MRI showed T2/FLAIR hyperintensity signal involving the cerebral white matter. The repeat MRI showed significant worsening of the T2 Flair hyperintensities in white matter (Figures 1A, 1B). Post-biopsy, the patient was administered a trial of steroids which did not change his course By this time, the patient’s cognitive decline came to a halt and was discharged to a nursing home. Patient’s follow-up visit after two months showed a significant improvement in his mental faculties along with near complete resolution of the white matter changes (Figure 1C).
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