Diagnosis of Delayed Post-Hypoxic Leukoencephalopathy (Grinker’s Myelinopathy) with MRI Using Divided Subtracted Inversion Recovery (dSIR) Sequences: Time for Reappraisal of the Syndrome?
<b>Background:</b> Delayed Post-Hypoxic Leukoencephalopathy (DPHL), or Grinker’s myelinopathy, is a syndrome in which extensive changes are seen in the white matter of the cerebral hemispheres with MRI weeks or months after a hypoxic episode. T<sub>2</sub>-weighted spin echo...
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2024-02-01
|
| Series: | Diagnostics |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2075-4418/14/4/418 |
| _version_ | 1827343708594372608 |
|---|---|
| author | Gil Newburn Paul Condron Eryn E. Kwon Joshua P. McGeown Tracy R. Melzer Mark Bydder Mark Griffin Miriam Scadeng Leigh Potter Samantha J. Holdsworth Daniel M. Cornfeld Graeme M. Bydder |
| author_facet | Gil Newburn Paul Condron Eryn E. Kwon Joshua P. McGeown Tracy R. Melzer Mark Bydder Mark Griffin Miriam Scadeng Leigh Potter Samantha J. Holdsworth Daniel M. Cornfeld Graeme M. Bydder |
| author_sort | Gil Newburn |
| collection | DOAJ |
| description | <b>Background:</b> Delayed Post-Hypoxic Leukoencephalopathy (DPHL), or Grinker’s myelinopathy, is a syndrome in which extensive changes are seen in the white matter of the cerebral hemispheres with MRI weeks or months after a hypoxic episode. T<sub>2</sub>-weighted spin echo (T<sub>2</sub>-wSE) and/or T<sub>2</sub>-Fluid Attenuated Inversion Recovery (T<sub>2</sub>-FLAIR) images classically show diffuse hyperintensities in white matter which are thought to be near pathognomonic of the condition. The clinical features include Parkinsonism and akinetic mutism. DPHL is generally regarded as a rare condition. <b>Methods and Results:</b> Two cases of DPHL imaged with MRI nine months and two years after probable hypoxic episodes are described. No abnormalities were seen on the T<sub>2</sub>-FLAIR images with MRI, but very extensive changes were seen in the white matter of the cerebral and cerebellar hemisphere on divided Subtraction Inversion Recovery (dSIR) images. dSIR sequences may produce ten times the contrast of conventional inversion recovery (IR) sequences from small changes in T<sub>1</sub>. The clinical findings in both cases were of cognitive impairment without Parkinsonism or akinetic mutism. <b>Conclusion:</b> The classic features of DPHL may only represent the severe end of a spectrum of diseases in white matter following global hypoxic injury to the brain. The condition may be much more common than is generally thought but may not be recognized using conventional clinical and MRI criteria for diagnosis. Reappraisal of the syndrome of DPHL to include clinically less severe cases and to encompass recent advances in MRI is advocated. |
| first_indexed | 2024-03-07T22:35:09Z |
| format | Article |
| id | doaj.art-0ab435d846d54459bc61745869a70e73 |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-07T22:35:09Z |
| publishDate | 2024-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-0ab435d846d54459bc61745869a70e732024-02-23T15:13:50ZengMDPI AGDiagnostics2075-44182024-02-0114441810.3390/diagnostics14040418Diagnosis of Delayed Post-Hypoxic Leukoencephalopathy (Grinker’s Myelinopathy) with MRI Using Divided Subtracted Inversion Recovery (dSIR) Sequences: Time for Reappraisal of the Syndrome?Gil Newburn0Paul Condron1Eryn E. Kwon2Joshua P. McGeown3Tracy R. Melzer4Mark Bydder5Mark Griffin6Miriam Scadeng7Leigh Potter8Samantha J. Holdsworth9Daniel M. Cornfeld10Graeme M. Bydder11Mātai Medical Research Institute, Tairāwhiti Gisborne 4010, New ZealandMātai Medical Research Institute, Tairāwhiti Gisborne 4010, New ZealandMātai Medical Research Institute, Tairāwhiti Gisborne 4010, New ZealandMātai Medical Research Institute, Tairāwhiti Gisborne 4010, New ZealandDepartment of Medicine, University of Otago, Christchurch 8011, New ZealandMātai Medical Research Institute, Tairāwhiti Gisborne 4010, New ZealandMātai Medical Research Institute, Tairāwhiti Gisborne 4010, New ZealandMātai Medical Research Institute, Tairāwhiti Gisborne 4010, New ZealandMātai Medical Research Institute, Tairāwhiti Gisborne 4010, New ZealandMātai Medical Research Institute, Tairāwhiti Gisborne 4010, New ZealandMātai Medical Research Institute, Tairāwhiti Gisborne 4010, New ZealandMātai Medical Research Institute, Tairāwhiti Gisborne 4010, New Zealand<b>Background:</b> Delayed Post-Hypoxic Leukoencephalopathy (DPHL), or Grinker’s myelinopathy, is a syndrome in which extensive changes are seen in the white matter of the cerebral hemispheres with MRI weeks or months after a hypoxic episode. T<sub>2</sub>-weighted spin echo (T<sub>2</sub>-wSE) and/or T<sub>2</sub>-Fluid Attenuated Inversion Recovery (T<sub>2</sub>-FLAIR) images classically show diffuse hyperintensities in white matter which are thought to be near pathognomonic of the condition. The clinical features include Parkinsonism and akinetic mutism. DPHL is generally regarded as a rare condition. <b>Methods and Results:</b> Two cases of DPHL imaged with MRI nine months and two years after probable hypoxic episodes are described. No abnormalities were seen on the T<sub>2</sub>-FLAIR images with MRI, but very extensive changes were seen in the white matter of the cerebral and cerebellar hemisphere on divided Subtraction Inversion Recovery (dSIR) images. dSIR sequences may produce ten times the contrast of conventional inversion recovery (IR) sequences from small changes in T<sub>1</sub>. The clinical findings in both cases were of cognitive impairment without Parkinsonism or akinetic mutism. <b>Conclusion:</b> The classic features of DPHL may only represent the severe end of a spectrum of diseases in white matter following global hypoxic injury to the brain. The condition may be much more common than is generally thought but may not be recognized using conventional clinical and MRI criteria for diagnosis. Reappraisal of the syndrome of DPHL to include clinically less severe cases and to encompass recent advances in MRI is advocated.https://www.mdpi.com/2075-4418/14/4/418delayed post-hypoxic leukoencephalopathyGrinker’s myelinopathytargeted MRI of the braindivided subtracted inversion recovery sequencesT<sub>1</sub>-bipolar filterwhite matter disease of the brain |
| spellingShingle | Gil Newburn Paul Condron Eryn E. Kwon Joshua P. McGeown Tracy R. Melzer Mark Bydder Mark Griffin Miriam Scadeng Leigh Potter Samantha J. Holdsworth Daniel M. Cornfeld Graeme M. Bydder Diagnosis of Delayed Post-Hypoxic Leukoencephalopathy (Grinker’s Myelinopathy) with MRI Using Divided Subtracted Inversion Recovery (dSIR) Sequences: Time for Reappraisal of the Syndrome? Diagnostics delayed post-hypoxic leukoencephalopathy Grinker’s myelinopathy targeted MRI of the brain divided subtracted inversion recovery sequences T<sub>1</sub>-bipolar filter white matter disease of the brain |
| title | Diagnosis of Delayed Post-Hypoxic Leukoencephalopathy (Grinker’s Myelinopathy) with MRI Using Divided Subtracted Inversion Recovery (dSIR) Sequences: Time for Reappraisal of the Syndrome? |
| title_full | Diagnosis of Delayed Post-Hypoxic Leukoencephalopathy (Grinker’s Myelinopathy) with MRI Using Divided Subtracted Inversion Recovery (dSIR) Sequences: Time for Reappraisal of the Syndrome? |
| title_fullStr | Diagnosis of Delayed Post-Hypoxic Leukoencephalopathy (Grinker’s Myelinopathy) with MRI Using Divided Subtracted Inversion Recovery (dSIR) Sequences: Time for Reappraisal of the Syndrome? |
| title_full_unstemmed | Diagnosis of Delayed Post-Hypoxic Leukoencephalopathy (Grinker’s Myelinopathy) with MRI Using Divided Subtracted Inversion Recovery (dSIR) Sequences: Time for Reappraisal of the Syndrome? |
| title_short | Diagnosis of Delayed Post-Hypoxic Leukoencephalopathy (Grinker’s Myelinopathy) with MRI Using Divided Subtracted Inversion Recovery (dSIR) Sequences: Time for Reappraisal of the Syndrome? |
| title_sort | diagnosis of delayed post hypoxic leukoencephalopathy grinker s myelinopathy with mri using divided subtracted inversion recovery dsir sequences time for reappraisal of the syndrome |
| topic | delayed post-hypoxic leukoencephalopathy Grinker’s myelinopathy targeted MRI of the brain divided subtracted inversion recovery sequences T<sub>1</sub>-bipolar filter white matter disease of the brain |
| url | https://www.mdpi.com/2075-4418/14/4/418 |
| work_keys_str_mv | AT gilnewburn diagnosisofdelayedposthypoxicleukoencephalopathygrinkersmyelinopathywithmriusingdividedsubtractedinversionrecoverydsirsequencestimeforreappraisalofthesyndrome AT paulcondron diagnosisofdelayedposthypoxicleukoencephalopathygrinkersmyelinopathywithmriusingdividedsubtractedinversionrecoverydsirsequencestimeforreappraisalofthesyndrome AT erynekwon diagnosisofdelayedposthypoxicleukoencephalopathygrinkersmyelinopathywithmriusingdividedsubtractedinversionrecoverydsirsequencestimeforreappraisalofthesyndrome AT joshuapmcgeown diagnosisofdelayedposthypoxicleukoencephalopathygrinkersmyelinopathywithmriusingdividedsubtractedinversionrecoverydsirsequencestimeforreappraisalofthesyndrome AT tracyrmelzer diagnosisofdelayedposthypoxicleukoencephalopathygrinkersmyelinopathywithmriusingdividedsubtractedinversionrecoverydsirsequencestimeforreappraisalofthesyndrome AT markbydder diagnosisofdelayedposthypoxicleukoencephalopathygrinkersmyelinopathywithmriusingdividedsubtractedinversionrecoverydsirsequencestimeforreappraisalofthesyndrome AT markgriffin diagnosisofdelayedposthypoxicleukoencephalopathygrinkersmyelinopathywithmriusingdividedsubtractedinversionrecoverydsirsequencestimeforreappraisalofthesyndrome AT miriamscadeng diagnosisofdelayedposthypoxicleukoencephalopathygrinkersmyelinopathywithmriusingdividedsubtractedinversionrecoverydsirsequencestimeforreappraisalofthesyndrome AT leighpotter diagnosisofdelayedposthypoxicleukoencephalopathygrinkersmyelinopathywithmriusingdividedsubtractedinversionrecoverydsirsequencestimeforreappraisalofthesyndrome AT samanthajholdsworth diagnosisofdelayedposthypoxicleukoencephalopathygrinkersmyelinopathywithmriusingdividedsubtractedinversionrecoverydsirsequencestimeforreappraisalofthesyndrome AT danielmcornfeld diagnosisofdelayedposthypoxicleukoencephalopathygrinkersmyelinopathywithmriusingdividedsubtractedinversionrecoverydsirsequencestimeforreappraisalofthesyndrome AT graemembydder diagnosisofdelayedposthypoxicleukoencephalopathygrinkersmyelinopathywithmriusingdividedsubtractedinversionrecoverydsirsequencestimeforreappraisalofthesyndrome |