Objective:

To report two cases of Delayed Post-Hypoxic Leukoencephalopathy (DPHL) associated with Mounjaro injections for weight loss, and Xanax intentional overdose, respectively.

Background:

DPHL is a rare and underrecognized condition of white matter injury provoked by cerebral hypoxia. Many physicians are not familiar with this entity which can lead to diagnostic uncertainty.

Design/Methods:

NA

Results:

Our patients presented to two different hospitals after being found unresponsive, each for an unknown duration. The first patient was a 65 yo woman self-medicating with Mounjaro for weight loss who was found down hypoglycemic (serum glucose 36) and hypotensive (blood pressure 50/30). The second patient was a 61 yo woman with depression who was found down after Xanax intentional overdose. They both returned to normal baseline mental status after few days of supportive treatment and were discharged home. Within the first month of their initial presentations, the two patients presented back to their respective hospitals with subacute progressive encephalopathy. MRI brain for both patients showed faint bilateral symmetric diffuse T2 FLAIR hyperintensities involving the white matter which became more evident on follow up MRIs. They both underwent extensive workup including multiple LPs, EEGs, CSF and serum testing for infectious, autoimmune/inflammatory, and paraneoplastic etiologies which were all negative. They were eventually transferred to our center for a second opinion, and upon careful review of history, clinical presentation, and MRI findings, they were diagnosed with Delayed Post-Hypoxic Leukoencephalopathy.

Conclusions:

DPHL is characterized by a biphasic presentation where there is a deceiving initial neurological improvement after a cerebral hypoxic event, only for further deterioration to occur shortly after. Obtaining a thorough and detailed history, along with recognizing the classic clinical presentation and imaging patterns should alert clinicians to such diagnosis, and can help avoid unnecessary expensive investigations and futile treatments.