Recovery of Acute Leukoencephalopathy Documented by Neuroimaging: A Case Report

Area of Science:

• Neurology
• Toxicology
• Neuroimaging

Background:

• Severe toxic leukoencephalopathy can result from synthetic cannabinoid use.
• Neurologic recovery from severe brain injury, such as coma or unresponsive wakefulness syndrome, can be complex.

Observation:

• A patient with presumed synthetic cannabinoid-induced toxic leukoencephalopathy exhibited an atypical, delayed neurologic recovery.
• Clinical status progressed from coma to a minimally conscious state over two months.
• Structural neuroimaging (CT, MRI) showed stable, extensive white matter lesions throughout the observation period.

Findings:

• Despite persistent structural damage, functional neuroimaging (FDG-PET) demonstrated a partial recovery of cortical metabolism after five months.
• This indicates a dissociation between structural integrity and functional brain recovery.

Implications:

• Recovery from toxic acute leukoencephalopathy can be delayed and atypical.
• Multimodal monitoring, combining behavioral assessments and functional neuroimaging, enhances prognosis reliability.
• Relying solely on early structural damage for prognosis may be misleading in cases of toxic leukoencephalopathy.