PDF(Pubmed)
Abstract：
Delayed post-hypoxic leukoencephalopathy (DPHL) is a poorly recognized syndrome characterized by neuropsychiatric symptoms following recovery from an acute hypoxic episode. Although most cases are related to carbon monoxide poisoning, some have been linked to excessive opioid use. Opioid intoxication has recently become known for manifesting the characteristic imaging findings involving cerebellar, hippocampal, and basal nuclei transient edema with restricted diffusion (CHANTER) syndrome. Herein, we present a patient with severe disturbances in consciousness who was initially diagnosed with CO poisoning but was later found to have taken excessive tramadol. Magnetic resonance imaging (MRI) in the acute phase revealed abnormal intensities in the bilateral globus pallidus and the cerebellum, indicative of CHANTER syndrome. After intensive care, his level of consciousness was restored. However, around the 3rd week after hospitalization, his consciousness gradually deteriorated and he developed severe neurological symptoms. Another MRI on day 25 revealed a new diffuse white matter abnormality; DPHL was suspected. Cerebrospinal fluid collected on day 28 revealed significantly elevated myelin basic protein levels. Although it was challenging to decide on a treatment plan, hyperbaric oxygen (HBO) therapy trials were initiated on day 58; the patient\'s condition improved after a series of HBO sessions. MRI revealed gradual shrinkage of the white matter abnormality. A total of 63 consecutive HBO sessions were performed, leading to the successful resolution of the serious neurological symptoms. While the effectiveness of HBO therapy for DPHL remains inconclusive, especially in opioid-related cases, this patient made a remarkable recovery, likely due to the therapeutic effect of improved cerebral blood flow and oxygenation.
摘要：
迟发性缺氧后白质脑病（DPHL）是一种鲜为人知的综合征，其特征是从急性缺氧发作中恢复后的神经精神症状。尽管大多数病例与一氧化碳中毒有关，有些与过量使用阿片类药物有关。最近，阿片类药物中毒以表现涉及小脑的特征性影像学表现而闻名。海马,基底核一过性水肿伴弥散受限(CHANTER)综合征。在这里，我们介绍了1例严重意识障碍患者,最初被诊断为CO中毒,但后来发现服用了过量曲马多.急性期磁共振成像（MRI）显示双侧苍白球和小脑的异常强度，表明CHANTER综合征。经过重症监护,他的意识水平恢复了。然而,住院后的第3周,他的意识逐渐恶化，出现严重的神经症状。第25天的另一次MRI显示新的弥漫性白质异常；怀疑是DPHL。在第28天收集的脑脊液显示髓磷脂碱性蛋白水平显着升高。尽管决定治疗计划很有挑战性，高压氧（HBO）治疗试验在第58天开始；患者的病情在一系列HBO治疗后得到改善。MRI显示白质异常逐渐缩小。总共进行了63次连续的HBO会议，导致严重的神经症状的成功解决。虽然HBO治疗DPHL的有效性仍不确定，尤其是在与阿片类药物有关的病例中，这个病人恢复得很好,可能是由于改善脑血流量和氧合的治疗效果。
