Delayed Post-Hypoxic Leukoencephalopathy Presenting with Catatonia Symptoms Sequelae of Opioid Overdose and Trauma

Delayed post-hypoxic leukoencephalopathy (DPHL) is a rare complication of hypoxic brain injury, which can present with a wide spectrum of symptoms 1-4 weeks after the incident. The diagnosis is supported by the presence of white matter changes on the magnetic resonance imaging (MRI). We present a 54-year-old Caucasian female with a 3-week history of opioid overdose and sexual trauma who presented to the hospital with symptoms of unresponsiveness, irritability, mobility issues, and aggressive and combative behavior for three days. Initially, substance abuse and infections were ruled out. A head computed tomography (CT) showed no acute findings. MRI of the brain without contrast & and T2-weighted fluid-attenuated inversion recovery (T2-FLAIR) without contrast showed extensive signal abnormalities throughout the white matter of bilateral cerebral hemispheres, which was suggestive of hypoxic brain injury. The onset of catatonia-like symptoms, along with imaging findings, supported the diagnosis of DPHL. The patient showed improvement after starting physical therapy and restarting the home dose of clonazepam. There are no standardized diagnostic criteria for DPHL, which makes it challenging for clinicians to diagnose. It is vital to keep DPHL in differential diagnosis, especially when there is a history of recent hypoxic injury, for optimal patient care.