ABSTRACT
Acute toxic leukoencephalopathy (ATL) and delayed post-hypoxic leukoencephalopathy (DPHL) are two possible adverse entities related to opioid intoxication (OI), each having a distinct clinical course. While ATL shows a monophasic course with gradual neurological deterioration, DPHL has a distinct biphasic course. We report a case of ATL along with a case of DPHL happening in young male patients with OI, including their clinical courses as well as imaging characteristics with comparable time intervals. Initially, both leukoencephalopathies typically show magnetic resonance imaging findings with confluent and symmetric white matter (WM) abnormalities in the periventricular regions on T2 and fluid-attenuated inversion recovery images along with restricted diffusion on diffusion-weighted imaging. The DPHL patient however also presented with WM cystic substance loss in the deterioration phase, several weeks after hospital admission, which was previously described in a case of DPHL. Interestingly, similar WM changes have recently been observed in virus-associated necrotizing disseminated acute leukoencephalopathy in patients with coronavirus disease 2019 which may suggest a common pathophysiological mechanism. Knowing the distinct imaging features of ATL and DPHL along with their typical clinical courses can provide a faster and more reliable differentiation between these two entities.
Subject(s)
Craniocerebral Trauma/therapy , Emergency Treatment , Accident Prevention , Adult , Child , Clinical Competence , Craniocerebral Trauma/complications , Craniocerebral Trauma/diagnosis , Craniocerebral Trauma/mortality , Emergency Medical Services/organization & administration , Emergency Medical Services/standards , Emergency Treatment/methods , Emergency Treatment/standards , Evidence-Based Medicine , Fluid Therapy , Glasgow Coma Scale , Humans , Injury Severity Score , Monitoring, Physiologic , Oxygen Inhalation Therapy , Practice Guidelines as Topic , Prognosis , Scandinavian and Nordic Countries/epidemiology , Transportation of PatientsABSTRACT
Head trauma is the cause the death for many young persons. The number of fatalities can be reduced through systematic management. Prevention of secondary brain injury combined with the fastest possible transport to a neurosurgical unit, have been shown to effectively reduce mortality and morbidity. Evidence-based guidelines already exist that focus on all steps in the process. In the present article members of the Scandinavian Neurotrauma Committee present recommendations on prehospital management of traumatic brain injury adapted to the infrastructure of the Nordic region.
Subject(s)
Brain Injuries , Emergency Medical Services/methods , Adult , Brain Injuries/diagnosis , Brain Injuries/mortality , Brain Injuries/therapy , Child , Evidence-Based Medicine , Fluid Therapy , Glasgow Coma Scale , Humans , Monitoring, Physiologic , Oxygen Inhalation Therapy , Practice Guidelines as Topic , Scandinavian and Nordic Countries/epidemiology , Transportation of Patients , Trauma CentersABSTRACT
Head trauma causes the death of many young persons. The number of fatalities can be reduced through systematic management. Preventing secondary brain injury together with the fastest possible transport to a neurosurgical unit has been shown to be effective in reducing mortality and morbidity. Evidence-based guidelines already exist that focus on all steps in the management. This article, which was written by members of the Scandinavian Neurotrauma Committee, presents recommendations on the pre-hospital management of traumatic brain injury adapted to the infrastructure of Scandinavia.
