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A Piglet Model of Neonatal Hypoxic-Ischemic Encephalopathy
Published on: May 16, 2015
[Delayed postanoxic encephalopathy]
F J Gascón Jiménez1, B Navarro Gochicoa, M J Velasco Jabalquinto
1Facultad de Medicina, Unidad Docente de Pediatría, Hospital Universitario Reina Sofía, Departamento de Pediatría, Córdoba.
Insights
Delayed postanoxic encephalopathy can occur after benzodiazepine intoxication, causing a relapse of neurological symptoms. This rare condition, affecting the basal ganglia, leads to permanent neurological deficits.
Area of Science:
- Neuroscience
- Toxicology
- Pediatric Neurology
Background:
- Benzodiazepine intoxication can lead to coma and acute respiratory distress syndrome.
- Delayed postanoxic encephalopathy is a rare, unexplained neurological condition.
- This syndrome manifests after an initial hypoxic-ischemic event.
Observation:
- A 9-year-old boy experienced delayed postanoxic encephalopathy following benzodiazepine intoxication.
- Initial recovery was followed by the onset of extrapyramidal rigidity and involuntary movements.
- Brain MRI revealed ischemic changes in the basal ganglia, consistent with anoxic-ischemic encephalopathy.
Findings:
- The patient presented with lead-pipe rigidity and cogwheel quality in passive movements.
- Neurological impairment progressed over weeks to months.
- The basal ganglia were disproportionately affected compared to the cerebral cortex and white matter.
Implications:
- This case highlights the potential for delayed postanoxic encephalopathy, particularly affecting the basal ganglia.
- The pathogenesis of this delayed neurological sequela remains unknown.
- Understanding this phenomenon is crucial for managing patients with severe intoxication and hypoxic events.
Abstract:
We report the case of a 9-year-old boy with delayed postanoxic encephalopathy. The patient improved after a period of coma and adult respiratory distress syndrome caused by benzodiazepine intoxication. Initial improvement appeared to be complete, but 9 days after discharge from the pediatric intensive care unit, extrapyramidal rigidity of the left arm became manifest. This event was followed by progressive neurologic impairment with involuntary, non-repetitive, but occasionally stereotyped movements, affecting distal, proximal and axial musculature in various combinations. On physical examination, passive movement of the left arm showed a plastic, lead-pipe rigidity with a ratchet-like cogwheel quality. Magnetic resonance imaging (MRI) was performed. Axial T 2 -weighted images of the brain showed characteristic signs of an ischemic area in the basal ganglia which were more evident in the right region, a finding consistent with anoxic-ischemic encephalopathy. Delayed postanoxic encephalopathy is a relatively uncommon and unexplained phenomenon which becomes manifest after an initial hypoxic-ischemic event that causes stupor or coma. The pathogenesis is unknown. Exceptionally, this syndrome can affect the basal ganglia more than the cerebral cortex and white matter. Initial improvement is followed after a variable period of time by relapse, progressing for weeks to months until the patient is left with permanent sequelae.
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