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- W2806198695 abstract "Objective: We describe a case of delayed post-hypoxic leukoencephalopathy (DPHL) in the setting of substance overdose and hypoxic brain injury, presenting as a primary psychiatric manifestation. Background: DPHL is a rare and under-recognized white-matter demyelinating syndrome characterized by acute onset of neuropsychiatric symptoms days to weeks following a period of cerebral hypo-oxygenation. Diffuse and confluent white matter changes are present on magnetic resonance imaging (MRI) particularly in the region of the centrum semiovale. DPHL can be diagnosed when the clinical history of neurological deterioration caused by an initial hypoxic event is followed by subsequent improvement to baseline, and then a relapse 1 – 4 weeks after the improvement occurs, along with characteristic imaging findings. Myelin basic protein (MBP), a marker of acute demyelination, can be valuable when considering suspected DPHL. Design/Methods: Case report and Literature review. Results: A 52-year-old female presented 2 weeks after she was discharged from the hospital for substance overdose associated hypoxic cerebral injury, with psychomotor retardation, bizarre behavior and loss of execute functioning. Neurological examination was notable for changes in mentation and was otherwise normal. Extensive workup, including infectious, metabolic, rheumatologic panels and drug screens was negative. MRI showed diffuse and confluent white matter changes sparing cerebellar and brainstem tracts, without gyral edema or contrast enhancement. Cerebrospinal fluid testing showed normal cell counts, glucose and protein, and elevated MBP at 20.98. The patient’s clinical presentation, characteristic imaging findings, elevated MBP and negative workup for other possible causes are most consistent with DPHL. Conclusions: Though rare, DPHL should be considered as a diagnosis when neuropsychiatric symptoms appear days to weeks after a hypoxic event. This is a unique case of DPHL that presented as an exclusive psychiatric manifestation. Although, treatment is mainly supportive, prompt recognition of DPHL, could negate extensive investigations and lead to better utilization of health resources. Disclosure: Dr. Jillella has nothing to disclose. Dr. Herrera has nothing to disclose. Dr. Deligtisch has nothing to disclose." @default.
- W2806198695 created "2018-06-13" @default.
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- W2806198695 date "2017-04-18" @default.
- W2806198695 modified "2023-09-23" @default.
- W2806198695 title "A Case of Delayed Post-Hypoxic Leukoencephalopathy Masquerading as a Primary Psychiatric Disorder (P1.155)" @default.
- W2806198695 hasPublicationYear "2017" @default.
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