Delayed-onset MRI findings in acute chorea related to anoxic brain injury

Area of Science:

• Neurology
• Radiology
• Toxicology

Background:

• Anoxic brain injury is a significant cause of neurological deficits.
• Abnormal movements, such as chorea, can be a manifestation of brain injury.
• Chlordiazepoxide toxicity is a known, albeit less common, cause of neurological compromise.

Observation:

• A young patient presented with acute chorea following anoxic brain injury attributed to chlordiazepoxide toxicity.
• Initial brain MRI 8 days post-event showed no abnormalities.
• A follow-up brain MRI 15 days post-event revealed T2 hyperintensities and contrast enhancement in the bilateral globus pallidi.

Findings:

• This case suggests that MRI evidence of basal ganglia lesions in anoxic brain injury may manifest with a delay after the onset of chorea.
• The delayed appearance of T2 hyperintensities and enhancement in the globus pallidus is a key observation.
• The temporal discrepancy between clinical presentation and initial imaging is notable.

Implications:

• Delayed neuroimaging findings should be considered in cases of anoxic brain injury presenting with movement disorders.
• This case highlights the potential for evolving lesions in the basal ganglia following hypoxic events.
• While anoxic brain injury is suspected, the interval with a normal MRI necessitates consideration of alternative or coexisting etiologies.