An unsuccessful trial of immunomodulatory therapy in delayed posthypoxic demyelination.
BACKGROUND
Delayed posthypoxic demyelination may rarely complicate an episode of severe hypoxia, with or without exposure to carbon monoxide. Following recovery from initial coma, progressive neurologic deterioration ensues with outcomes ranging from death to full recovery. Delayed posthypoxic demyelination is hypothesized to be immunemediated, with support coming from recent animal experiments.


METHODS
We report a 46-year-old man who developed progressive cognitive deficits with abulia approximately 3 weeks after recovering from coma related to alcohol and morphine intoxication.


RESULTS
Despite treatment with high-dose steroids and plasmapheresis, he continued to deteriorate and remained in a vegetative state until his death under hospice care more than 2 months after his initial hypoxic insult. Serial brain imaging and postmortem examination showed bilateral necrosis of the globi pallidi and extensive demyelination in the centrum semiovale and corona radiata.


CONCLUSIONS
Based on an immune-mediated model of disease and given a lack of effective treatments, future use of immunomodulatory therapy may still be worth considering early in the course of this rare and potentially devastating condition.
Khot
Sandeep
S
Department of Neurology, University of Washington, Seattle, WA 98104, United States. skhot@u.washington.edu
Walker
Melanie
M
Lacy
J Matthew
JM
Oakes
Patricia
P
Longstreth
W T
WT
D000435:Alcoholic Intoxication / Q000150:complications; D003711:Demyelinating Diseases / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D002534:Hypoxia, Brain / Q000150:complications*; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use*; D008875:Middle Aged; D009021:Morphine Dependence / Q000150:complications; D018696:Neuroprotective Agents / Q000627:therapeutic use*; D010956:Plasmapheresis; D017211:Treatment Failure
D018696:Neuroprotective Agents; D008775:Methylprednisolone