Citation

Rolf LM, Sikkema T, Krudde J, van Harten B. Ned. Tijdschr. Geneeskd. 2014; 158(3).

Copyright

(Copyright © 2014, Erven Bohn)

DOI

unavailable

PMID

unavailable

Abstract

BACKGROUND: The differential diagnosis of cerebral white matter lesions is extensive and among the possibilities is Delayed Post-Hypoxic Leukoencephalopathy (DPHL). This is a demyelinating syndrome, characterized by neuropsychiatric symptoms occurring several days to weeks after cerebral hypoxia. It has been first described in context of intoxication with carbon monoxide, but it is also seen in cases of drugs overdose or another global cerebral hypoxic event. Recognition of this syndrome might be difficult because of the interval, and might lead to a delay in diagnosis and a cascade of diagnostics. Case description: We describe a 50-year old female patient, who showed a rapid clinical deterioration with apathy, mutism and regressive behavior during psychiatric hospitalization after an autointoxication with carbon monoxide, eventually leading to a state of akinetic-mutism. Magnetic resonance imaging (MRI) of the brain showed diffuse white matter abnormalities. These radiographic features combined with the clinical presentation were highly suggestive for DPHL. Treatment of the patient consisted of supportive care with a multidisciplinary approach. She showed a gradually clinical improvement over weeks and left the hospital after six weeks for additional rehabilitation. Six months after initial symptoms she showed a remarkable clinical improvement and hardly any signs or symptoms were still present at that time.

CONCLUSION: This case highlights that if a psychiatric patient deteriorates quickly, a neurological cause should be considered. Recognizing DPHL is important because it can prevent unnecessary (invasive) diagnostics and treatments. Considering the favorable natural course of DPHL appropriate measures should be taken in order to provide supportive care and rehabilitation.

Language: nl

Keywords

adult; human; female; case report; suicide attempt; article; behavior disorder; carbon monoxide intoxication; middle aged; nuclear magnetic resonance imaging; apathy; mutism; leukoencephalopathy; white matter lesion; delayed post hypoxic leukoencephalopathy; white matter abnormality