Clinical and Diagnostic Features of Delayed Hypoxic Leukoencephalopathy

Shprecher, David; Flanigan, Maureen; Smith, A. Gordon; Smith, Shawn; Schenkenberg, Thomas; Steffens, John

doi:10.1176/jnp.2008.20.4.473

Cited by 42 publications

(23 citation statements)

References 18 publications

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“…The DPL and control cases did not have long TE spectra, however, the short TE spectrum suggest the presence of lactate in the DPL case (Figure 2A). This spectral pattern has been previously reported in the setting of DPL following carbon monoxide poisoning or medication overdose (10)(11)(12). Prolonged impaired oxygenation to the subcortical white matter is thought to promote anaerobic metabolism and leads to elevated tissue lactate (11,12).…”

Section: Case Seriessupporting

confidence: 68%

See 1 more Smart Citation

Brain MR Spectroscopic Findings in Three Consecutive Covid-19 Patients: Preliminary Observations

Rapalino

Weerasekera

Moum

et al. 2020

Preprint

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Brain magnetic resonance spectroscopic imaging (MRSI) was performed in three consecutive COVID-19 patients, as part of a pilot investigation of the pathophysiological processes underlying the brain involvement by the SARS-CoV-2 infection. These included one with necrotizing leukoencephalopathy, one after recent PEA cardiac arrest without leukoencephalopathy, and one without frank encephalopathy or recent severe hypoxic episode. The MRSI findings were compared to those of two patients with white matter pathology not SARS-CoV2 infection related, and a control patient without clinical encephalopathy. The N-acetyl-aspartate reduction, choline elevation, and glutamate/glutamine elevation found in the COVID necrotizing leukoencephalopathy patient and, to a lesser degree, the COVID post-cardiac arrest patient, follow a similar pattern as seen with the delayed post-hypoxic leukoencephalopathy patient. Lactate elevation was most pronounced in the patient with COVID necrotizing leukoencephalopathy.

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Section: Case Seriessupporting

confidence: 68%

“…This spectral pattern has been previously reported in the setting of DPL following carbon monoxide poisoning or medication overdose(10–12). Prolonged impaired oxygenation to the subcortical white matter is thought to promote anaerobic metabolism and leads to elevated tissue lactate(11, 12).…”

Section: Discussionmentioning

confidence: 99%

Brain MR Spectroscopic Findings in Three Consecutive Covid-19 Patients: Preliminary Observations

Rapalino

Weerasekera

Moum

et al. 2020

Preprint

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show abstract

“…(3,7) Pathologically, it is characterised by diffuse hemispheric demyelination sparing the subcortical U-fibres, but without vacuolisation. (8) Rizzuto et al reported a case of intravenous heroin abuse in which the clinical picture was consistent with post-anoxic encephalopathy, but a pathological study suggested spongiform leucoencephalopathy. (9) MR imaging findings were also consistent with TLE.…”

Section: Discussionmentioning

confidence: 99%

Toxic leucoencephalopathy after ‘chasing the dragon’

Singh

Saini

2015

smedj

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“…This spectral pattern has been previously reported in the setting of DPL following carbon monoxide poisoning or medication overdose. [13][14][15] Prolonged impaired oxygenation to the subcortical white matter is thought to promote anaerobic metabolism and leads to elevated tissue Lactate. 14,15 The observed increase of Cho/Cr ratios in the patients with leukoencephalopathy, particularly in the case of COVID-associated necrotizing leukoencephalopathy, likely reflects demyelination within these white matter lesions as recently described in an initial neuropathologic study of a patient with COVID-19.…”

Section: Discussionmentioning

confidence: 99%

Brain MR Spectroscopic Findings in 3 Consecutive Patients with COVID-19: Preliminary Observations

Rapalino¹,

Weerasekera

Moum

et al. 2020

AJNR Am J Neuroradiol

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Brain multivoxel MR spectroscopic imaging was performed in 3 consecutive patients with coronavirus disease 2019 . These included 1 patient with COVID-19-associated necrotizing leukoencephalopathy, another patient who had a recent pulseless electrical activity cardiac arrest with subtle white matter changes, and a patient without frank encephalopathy or a recent severe hypoxic episode. The MR spectroscopic imaging findings were compared with those of 2 patients with white matter pathology not related to Severe Acute Respiratory Syndrome coronavirus 2 infection and a healthy control subject. The NAA reduction, choline elevation, and glutamate/glutamine elevation found in the patient with COVID-19-associated necrotizing leukoencephalopathy and, to a lesser degree, the patient with COVID-19 postcardiac arrest, follow a similar pattern as seen with the patient with delayed posthypoxic leukoencephalopathy. Lactate elevation was most pronounced in the patient with COVID-19 necrotizing leukoencephalopathy.

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Clinical and Diagnostic Features of Delayed Hypoxic Leukoencephalopathy

Cited by 42 publications

References 18 publications

Brain MR Spectroscopic Findings in Three Consecutive Covid-19 Patients: Preliminary Observations

Brain MR Spectroscopic Findings in Three Consecutive Covid-19 Patients: Preliminary Observations

Toxic leucoencephalopathy after ‘chasing the dragon’

Brain MR Spectroscopic Findings in 3 Consecutive Patients with COVID-19: Preliminary Observations

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