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Case Reports
. 2018 Apr 15;10(4):e2481.
doi: 10.7759/cureus.2481.

Delayed Post-hypoxic Leukoencephalopathy: A Case Series and Review of the Literature

Nakul Katyal  1 , Naureen Narula  2 , Pravin George  3 , Premkumar Nattanamai  1 , Christopher R Newey  3 , Jonathan M Beary  4
Affiliations
Case Reports

Delayed Post-hypoxic Leukoencephalopathy: A Case Series and Review of the Literature

Nakul Katyal et al. Cureus. .

Abstract

Delayed post-hypoxic leukoencephalopathy (DPHL) is a unique clinical entity that presents with cognitive impairment days to weeks after an episode of acute hypoxic brain injury. Frequently hypoxia is unrecognized as a mechanism for clinical decline and extensive workup ensues. We present two cases of DPHL highlighting the neuroimaging findings. In both patients, a cerebral hypoxic event was followed by a recovery phase with subsequent delayed clinical decline. Patient 1 suffered hypoxia from drug-induced respiratory depression and lack of post-operative positive airway pressure (PAP) support. Her neurological exam on follow-up revealed progressive cognitive decline. Magnetic resonance imaging (MRI) brain showed bilateral white matter changes involving the centrum semiovale. Patient 2 developed a generalized tonic-clonic seizure during an endobronchial biopsy procedure and was found to have multiple air emboli on computed tomography (CT) head scan. She was initially in a drug-induced coma for her seizures. Electroencephalography (EEG) on day 14 of admission showed changes consistent with diffuse encephalopathy. MRI brain showed bilateral white matter changes particularly at the watershed zones and in the centrum semiovale. DPHL is a rare and under-recognized clinical entity that requires clinical suspicion and detailed evaluation for diagnosis. Neuroimaging studies can provide prognostic information regarding the extent of neurological injury.

Keywords: post hypoxic leukoencephalopathy.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Magnetic resonance imaging (MRI).
MRI brain showing nonspecific white matter changes supratentorially (circles).
Figure 2
Figure 2. Computed tomography (CT) head.
CT head showing multiple air emboli (arrow).
Figure 3
Figure 3. Magnetic resonance imaging (MRI).
MRI brain scan showing diffuse white matter changes (circles).
See this image and copyright information in PMC

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