A Case of Delayed-Onset Posthypoxic Leukoencephalopathy in a Pediatric Patient

We present a 16-year-old female status post traumatic brain injury from severe motor vehicle crash with prolonged extrication. Initially with a Glasgow Coma Scale of 4 and blood pressure of 80/40, she required emergent intubation. Head computed tomography was notable for skull fracture with hematoma, diffuse axonal injury, and 6-mm midline shift with right uncal herniation. On hospital day 1, she underwent decompressive R hemicraniectomy. She received neuroprotective treatment including a hypocarbic, hypernatremic state with close blood pressure monitoring for appropriate cerebral perfusion. On hospital day 4, patient was extubated and weaned off pressors and hypertonic saline. On hospital day 6, she was able to get out of bed to a chair, was speaking some words, following commands, and tolerating bites of food. On hospital day 8, she developed sudden agitation, combativeness, confusion, and could no longer follow commands. Magnetic resonance imaging now demonstrated confluent restricted diffusion consistent with acute changes. Imaging and examination findings were consistent with delayed-onset posthypoxic leukoencephalopathy.