Hypoxic arrest in the setting of drug use.
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White matter of the cerebral hemispheres and the corpus callosum demonstrate restricted diffusion.
There is relative sparing of the grey matter.
The extensive white matter are in keeping with severe leukoencephalopathy.
In this case, it is difficult to clearly establish whether the underlying etiology for the leukoencephalopathy evident on MRI was secondary to the toxic stimulus or secondary to the associated hypoxic event.
There can be considerable radiological overlap between toxic leukoencephalopathy and post hypoxic encephalopathy. One of the hallmarks of delayed hypoxic encephalopathy is the clinical biphasic pattern of deterioration, where there is normally an initial improvement and then neurological decline. The clinical follow up in this case was limited however there was suggestion of a relatively bi-phasic pattern of deterioration, and so a delayed hypoxic leukoencephalopathy is a good differential for the underlying etiology in this setting. This patient was treated as a toxic encephalopathy case given the history of drug overdose.
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- 2. Filley CM, McConnell BV, Anderson CA. The Expanding Prominence of Toxic Leukoencephalopathy. J Neuropsychiatry Clin Neurosci. 2017 Fall;29(4):308-318. doi: 10.1176/appi.neuropsych.17010006.