Editorial Comment

This case with delayed deterioration, bilateral globus pallidus necrosis, and neurologic symptoms that resolved over time is very interesting and can be discussed from a number of different angles. The occurrence of delayed necrosis of the basal ganglia following a hypoxic-ischemic injury or a hypoxic injury alone has been known for a long time. The role of the intoxicating agent is not clearly delineated in this phenomenon, and in my view, it is probable that the overlap in the distribution of involvement is such that the elaborate descriptions of the distribution of injury with any particular intoxicating agent (with the exception of those who “chase the dragon” or those who inhale heroin who show leukoencephalopathy rather than gray-matter involvement) are not distinctive in practice. Regardless of the agent, these injuries probably share the same mechanism which is, I think, insufficient oxygen (hypoxia) alone or hypoxic-ischemic injury where there is circulatory failure in addition to the hypoxia.

Source: Seminars in Pediatric Neurology - June 11, 2014 Category: Neurology Authors: John B. Bodensteiner Source Type: research