Delayed Hypoxic Leukoencephalopathy In A Substance Abuse Patient: A Case Report

Objective: A 33-year-old man, after substances overdose developed acute respiratory failure. Consequences of this are delirium and bilateral hypoxic damage to globus pallidus in MRI. Forty days after remission, his mental status worsened quickly. Patient showed grossly disorganized thinking and behaviour, severe memory impairment. Neurological examination revealed diffuse hypertonia and brisky deep tendon reflex. MRI showed bilateral diffuse demyelination of frontal, parietal, temporal and peritrigonal white matter. Pharmacotherapy with neuroleptics was ineffective. The syndrome lasted one month and ended quickly. Attenuating disorganized thought and behaviour, cognitive core of syndrome progressively shifted to loss of initiative, lassitude and indifference. Despite the complete cognitive recovery with normalization of cognitive tests, emotional response remained stiff with perseveration, tendency to indifference and stereotypical trend of happiness. This is the second case in literature in which after globus pallidus lesion, craving disappears and patient become temporary abstinent.Conclusions: Delayed hypoxic leukoencephalopathy is a syndrome to consider when delayed onset of neuropsychiatric symptoms follows a hypoxic event. MRI allows a clear diagnosis. Psychotropic medication should be minimized, avoiding antipsychotic because of increased risk of extrapiramidal side effects and unpredictability of clinical results.