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Diagnosis of Delayed Post-Hypoxic Leukoencephalopathy (Grinker’s Myelinopathy) with MRI Using Divided Subtracted Inversion Recovery (dSIR) Sequences: Time for Reappraisal of the Syndrome?

Authors :
Gil Newburn
Paul Condron
Eryn E. Kwon
Joshua P. McGeown
Tracy R. Melzer
Mark Bydder
Mark Griffin
Miriam Scadeng
Leigh Potter
Samantha J. Holdsworth
Daniel M. Cornfeld
Graeme M. Bydder
Source :
Diagnostics, Vol 14, Iss 4, p 418 (2024)
Publication Year :
2024
Publisher :
MDPI AG, 2024.

Abstract

Background: 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. T2-weighted spin echo (T2-wSE) and/or T2-Fluid Attenuated Inversion Recovery (T2-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. DPHL is generally regarded as a rare condition. Methods and Results: Two cases of DPHL imaged with MRI nine months and two years after probable hypoxic episodes are described. No abnormalities were seen on the T2-FLAIR images with MRI, but very extensive changes were seen in the white matter of the cerebral and cerebellar hemisphere on divided Subtraction Inversion Recovery (dSIR) images. dSIR sequences may produce ten times the contrast of conventional inversion recovery (IR) sequences from small changes in T1. The clinical findings in both cases were of cognitive impairment without Parkinsonism or akinetic mutism. Conclusion: The classic features of DPHL may only represent the severe end of a spectrum of diseases in white matter following global hypoxic injury to the brain. The condition may be much more common than is generally thought but may not be recognized using conventional clinical and MRI criteria for diagnosis. Reappraisal of the syndrome of DPHL to include clinically less severe cases and to encompass recent advances in MRI is advocated.

Details

Language :
English
ISSN :
20754418
Volume :
14
Issue :
4
Database :
Directory of Open Access Journals
Journal :
Diagnostics
Publication Type :
Academic Journal
Accession number :
edsdoj.0ab435d846d54459bc61745869a70e73
Document Type :
article
Full Text :
https://doi.org/10.3390/diagnostics14040418