title: Delayed Posthypoxic Leukoencephalopathy: Improvement with Antioxidant Therapy.
abstract: BACKGROUND
  Delayed posthypoxic leukoencephalopathy (DPHL) may result from a variety of hypoxic insults, including respiratory depression from an opiate overdose. The underlying pathophysiological mechanism of DPHL remains uncertain. We describe a patient with a typical case of DPHL who responded clinically to antioxidant treatment.
  
  
  METHODS
  Clinical, serological, and radiographic investigations were undertaken in the evaluation of the patient.
  
  
  RESULTS
  A 63-year-old man developed altered mental status 10 days following recovery from an opiate overdose and aspiration pneumonia that required intubation. The clinical course and brain imaging were consistent with DPHL. Initiation of antioxidant therapy with vitamin E, vitamin C, B-complex vitamins, and coenzyme Q10 coincided with the prompt reversal of clinical deterioration.
  
  
  CONCLUSIONS
  The potential therapeutic effect of antioxidants on DPHL needs to be explored in future cases. If this relationship indeed holds true, it would be consistent with the hypothesis that formation of reactive oxygen species during reperfusion plays a role in the pathophysiology of this disorder.
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital and McLean Hospital, Boston, Mass., USA.
authors.forename: Franklin
authors.initials: F
authors.lastname: King
authors.affiliation: Department of Neurology, Columbia Presbyterian Hospital and Cornell Presbyterian Hospital, New York, N.Y., USA.
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Morris
authors.affiliation: Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Mass., USA.
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Schmahmann
keywords: Anoxia; Antioxidants; Delayed posthypoxic leukoencephalopathy; Hypoxia; Leukoencephalopathy; Overdose