Delayed post-hypoxic leukoencephalopathy with a peculiar autoantibody association

Delayed post-hypoxic leukoencephalopathy (DPHLE) is a rare demyelinating syndrome that follows an episode of prolonged cerebral hypoxia after a relatively lucid intervening period of variable length. Although the pathophysiology still remains obscure, it has been suggested that hypoxic-metabolic injuries to oligodendrocytes may play a crucial role. We describe the case of a patient with chronic respiratory problems who fell into a coma during morphine therapy. After a brief period of successful recovery, neurocognitive and behavioral disorders suddenly appeared and a diagnosis of DPHLE was made also taking into account the MRI picture. The antioxidant therapy has probably facilitated the almost complete neurological recovery within 4 weeks. A peculiar finding was the presence of anti-CV2/CRMP5 antibodies in serum, which may stand as potential factors implicated in oligodendrocytes damage.