Unilateral delayed post‑hypoxic leukoencephalopathy: a case report

Journal of Medical Case Reports, 2022 · DOI: 10.1186/s13256-022-03701-3 · Published: November 30, 2022

Neuroimaging Neurology Research Methodology & Design

Simple Explanation

Delayed post-hypoxic leukoencephalopathy (DPHL) is a rare condition that can occur after a period of oxygen deprivation to the brain. It's characterized by a decline in neurological function following a period of stability or improvement. This case report describes an instance where DPHL-like symptoms and brain changes occurred on only one side of the brain in a patient who had a blocked carotid artery treated with a revascularization procedure. The findings suggest that DPHL can occur not only after global oxygen deprivation but also after localized oxygen deprivation due to a blocked blood vessel in the brain.

Study Duration

Not specified

Participants

One 81-year-old man

Evidence Level

Level 4: Case Report

Key Findings

1
Clinical symptoms suggestive of delayed post-hypoxic leukoencephalopathy (DPHL) can be observed in very rare cases following successful revascularization therapy in large vessel occlusions, causing acute ischemic stroke.
2
Radiological signs of DPHL may be subtle, can be unilateral, and therefore can be easily overlooked.
3
Repeated controls using magnetic resonance imaging (MRI) is necessary to correlate and monitor the clinical course and the morphological changes of the brain over time.

Research Summary

This case report describes an 81-year-old man who developed unilateral delayed post-hypoxic leukoencephalopathy (DPHL) following a dissection-related occlusion of the left carotid artery. The patient showed clinical improvement after endovascular stroke therapy but later experienced cognitive deterioration, followed by gradual recovery. MRI findings were characteristic of DPHL but localized unilaterally to the left anterior circulation. This case suggests that DPHL can occur with localized hypoxia due to large vessel occlusion, not just global hypoxia, and that radiological signs can be subtle and unilateral.

Practical Implications

Increased Awareness

Clinicians should be aware that DPHL can manifest unilaterally following acute ischemic stroke treatment.

Careful Monitoring

Repeated MRI controls are necessary to monitor the clinical course and morphological brain changes in patients at risk.

Differential Diagnosis

Unilateral DPHL should be considered in the differential diagnosis of patients presenting with delayed neurological deterioration after stroke.

Study Limitations

1
The first MRI was performed on day 10 after the index event, so early changes on DWI may have been missed.
2
Findings are based on a single case and may not be generalizable.
3
The possibility of other metabolic or toxic disorders, although investigated, could not be entirely ruled out.

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