title: An unsuccessful trial of immunomodulatory therapy in delayed posthypoxic demyelination.
abstract: 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.
authors.affiliation: Department of Neurology, University of Washington, Seattle, WA 98104, United States. skhot@u.washington.edu
authors.forename: Sandeep
authors.initials: S
authors.lastname: Khot
authors.forename: Melanie
authors.initials: M
authors.lastname: Walker
authors.forename: J Matthew
authors.initials: JM
authors.lastname: Lacy
authors.forename: Patricia
authors.initials: P
authors.lastname: Oakes
authors.forename: W T
authors.initials: WT
authors.lastname: Longstreth
mesh_terms: 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
chemical_list: D018696:Neuroprotective Agents; D008775:Methylprednisolone