Szymkowicz Emilie, Neumann Olga, Sanz Leandro R D, Gosseries Olivia, Thibaut Aurore, Cavaliere Carlo, Laureys Steven, Liepert Joachim
Coma Science Group (ES, LRS, OG, AT, SL), GIGA-Consciousness, University of Liège; Centre du Cerveau2 (ES, LRDS, OG, AT, SL), University Hospital of Liège, Belgium; Kliniken Schmieder (ON, JL), Allensbach, Germany; and IRCCS SYNLAB SDN (CC), Naples, Italy.
Neurol Clin Pract. 2023 Dec;13(6):e200203. doi: 10.1212/CPJ.0000000000200203. Epub 2023 Oct 2.
We describe an atypical delayed neurologic recovery from coma and unresponsive wakefulness syndrome (i.e., persistent vegetative state) in a patient with severe drug-induced toxic leukoencephalopathy (presumably due to synthetic cannabinoid intake).
The patient underwent standardized behavioral and multimodal neuroimaging assessments to monitor clinical evolution and brain function over a 5-month period after presumed intoxication.
A progressive clinical recovery was observed, from an initial state of coma to emergence from a minimally conscious state after 2 months. Despite the stability of extensive white matter lesions documented by CT and structural MRI, fluorodeoxyglucose PET showed partial recovery of cortical metabolism after 5 months.
This case report illustrates that the temporal dynamics of recovery from toxic acute leukoencephalopathy may be atypical and delayed. Multimodal monitoring with repeated behavioral and functional neuroimaging assessments tends to improve the prognosis reliability, while early prognosis based on structural damage may result in misleading statements.
我们描述了一名患有严重药物性中毒性白质脑病（推测因摄入合成大麻素所致）的患者，从昏迷和无反应觉醒综合征（即持续性植物状态）中出现非典型延迟性神经功能恢复的情况。
在假定中毒后的5个月内，对该患者进行了标准化行为和多模态神经影像学评估，以监测临床进展和脑功能。
观察到患者临床症状逐渐恢复，从最初的昏迷状态到2个月后从最低意识状态苏醒。尽管CT和结构MRI显示广泛白质病变稳定，但氟脱氧葡萄糖PET显示5个月后皮质代谢部分恢复。
本病例报告表明，中毒性急性白质脑病恢复的时间动态可能是非典型且延迟的。通过重复行为和功能神经影像学评估进行多模态监测有助于提高预后可靠性，而基于结构损伤的早期预后可能会导致误导性判断。
