Delayed Post-Hypoxic Leukoencephalopathy: A Case Report and Literature Review (P06.179)

Abstract

Objective: To report a case of delayed post-hypoxic leukoencephalopathy (DPHL) and review the literature. Background DPHL has been described after exposure to opiates, benzodiazepines, carbon monoxide, surgical anesthesia and other agents. Since the first description in 1979, fewer than 20 cases have been reported, and information on clinical, imaging and especially histopathological features is scanty. Design/Methods: Chart review and literature search using PubMed. Results: A 52-year-old man with a history of tobacco and marijuana use was found unresponsive at home in January 2011. He was admitted to the intensive care unit, intubated, and treated for aspiration pneumonia. Upon extubation he appeared to be cognitively intact, but shortly thereafter experienced a cognitive decline, became unresponsive, and was transferred to neurology service in February. MRI of the brain showed diffuse nonspecific white matter disease and EEG showed moderate generalized nonspecific cerebral dysfunction. He was treated with vancomycin, ceftriaxone, and acyclovir for presumed encephalitis but cerebrospinal fluid showed no infectious etiology. As he continued to be in a persistent vegetative state a brain biopsy was performed and showed intact grey matter but extensive white matter degeneration with vacuolization, reactive astrocytosis, and a robust macrophage infiltrate. He was discharged to a skilled nursing facility with minimal change in his neurological status. By April, he began to communicate and move his left side purposefully. A repeat MRI in July continued to show necrotic white matter. He continued to improve and at the last follow-up in July 2011, he was oriented to self, place and time, and had normal speech and naming. Conclusions: DPHL typically occurs 1-2 weeks after apparent recovery from an insult. MRI shows extensive white matter changes with sparing of brainstem and cerebellum. As our case shows, extensive recovery can occur. Disclosure: Dr. Andresen has nothing to disclose. Dr. Kleinfeld has nothing to disclose. Dr. Pawate has nothing to disclose.