title: [Delayed posthypoxic leukoencephalopathy: case reports].
abstract: Delayed posthypoxic leukoencephalopathy (DPL) is a rare and less well known complication of hypoxic brain injury. Although it is well known that anoxic or hypoxic injury produces acute neurologic deficits, DPL typically manifests days to weeks after apparent recovery from an obtunded state, and patients with DPL demonstrate cognitive impairment, high brain dysfunction, parkinsonism, or psychosis. MRI findings of the brain demonstrate deep white matter abnormalities. We report 2 cases of DPL after hypoxia due to benzodiazepine overdose. Both of our patients had normal arylsulfatase A activity. Although DPL is seen in carbon monoxide poisoning, pseudodeficiency of arylsulfatase A activity, or drug overdose with heroin or morphine, there are only some previous studies of DPL caused by an overdose with benzodiazepine. It is unclear whether neurotoxicity from the drug in addition to hypoxia alone is involved, however, it is important to note that overdose of common drugs as sleeping medicine can cause DPL. Since DPL may often be misdiagnosed and be subjected to unnecessary treatments, it is also important to understand its unique clinical course and MRI findings. With prompt recognition of DPL, we expect that more cases of DPL caused by overdose with benzodiazepine will be diagnosed, because benzodiazepine overdoses are common.
authors.affiliation: Department of Neurology, Hyogo Rehabilitation Center Hospital.
authors.forename: Shiho
authors.initials: S
authors.lastname: Okuda
authors.forename: Masao
authors.initials: M
authors.lastname: Ueno
authors.forename: Michiko
authors.initials: M
authors.lastname: Hayakawa
authors.forename: Manabu
authors.initials: M
authors.lastname: Araki
authors.forename: Fumio
authors.initials: F
authors.lastname: Kanda
authors.forename: Shin
authors.initials: S
authors.lastname: Takano
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000009:adverse effects*; D001569:Benzodiazepines / Q000009:adverse effects*; D001921:Brain / Q000473:pathology; D003244:Consciousness Disorders / Q000209:etiology; D062787:Drug Overdose / Q000150:complications*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects*; D000860:Hypoxia / Q000209:etiology*; D056784:Leukoencephalopathies / Q000175:diagnosis* / Q000209:etiology* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013406:Suicide, Attempted; D013997:Time Factors
chemical_list: D000928:Antidepressive Agents; D006993:Hypnotics and Sedatives; D001569:Benzodiazepines