Grinker's myelinopathy: The rarely reported consequence of hypoxic brain injury.

Radiol Case Rep

Department of Radiodiagnosis, Govt. T.D Medical College, Alappuzha, Alappuzha, Kerala, India.

Published: November 2021

A 68-year-old woman presented with chest pain and loss of consciousness following an anterior wall myocardial infarction. Magnetic resonance imaging of brain showed features of hypoxic brain injury. She subsequently developed memory deficits, drowsiness and behavioral changes. Magnetic resonance imaging of brain done 4 months after ischemic insult showed evidence of delayed posthypoxic leukoencephalopathy also known as Grinker's myelinopathy.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8403719PMC
http://dx.doi.org/10.1016/j.radcr.2021.07.083DOI Listing

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Article Synopsis
  • Delayed post hypoxic leukoencephalopathy syndrome (DPHLS) is a rare neurological condition that emerges weeks after hypoxia, causing cognitive and neurological deficits that are challenging to diagnose and treat.
  • The study aims to gather and synthesize existing knowledge on DPHLS, focusing on its biological mechanisms, symptoms, diagnostic methods, and management while identifying areas needing more research.
  • A review of 73 cases indicated that hypoxia often results from substance overdoses (like benzodiazepines and opioids), with common symptoms including cognitive decline and abnormal neuroimaging findings showing changes in the brain's white matter.
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Ultra-high contrast (UHC) MRI describes forms of MRI in which little or no contrast is seen on conventional MRI images but very high contrast is seen with UHC techniques. One of these techniques uses the divided subtracted inversion recovery (dSIR) sequence, which, in modelling studies, can produce ten times the contrast of conventional inversion recovery (IR) sequences. When used in cases of mild traumatic brain injury (mTBI), the dSIR sequence frequently shows extensive abnormalities in white matter that appears normal when imaged with conventional T-fluid-attenuated IR (T-FLAIR) sequences.

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Delayed Post-Hypoxic Leukoencephalopathy (DPHL), or Grinker's myelinopathy, is a syndrome in which extensive changes are seen in the white matter of the cerebral hemispheres with MRI weeks or months after a hypoxic episode. T-weighted spin echo (T-wSE) and/or T-Fluid Attenuated Inversion Recovery (T-FLAIR) images classically show diffuse hyperintensities in white matter which are thought to be near pathognomonic of the condition. The clinical features include Parkinsonism and akinetic mutism.

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A 68-year-old woman presented with chest pain and loss of consciousness following an anterior wall myocardial infarction. Magnetic resonance imaging of brain showed features of hypoxic brain injury. She subsequently developed memory deficits, drowsiness and behavioral changes.

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A female patient, aged 61 years, presented to us with a 3-day history of fever and altered sensorium. She was discharged from another hospital 1 week back where she was admitted for community-acquired pneumonia. She was put on mechanical ventilation for threatened airway and her magnetic resonance brain imaging showed evidence of delayed posthypoxic leucoencephalopathy, also known as Grinker's myelinopathy.

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