The Spastic Weakness of the Lower Extremities Following Methadone Poisoning: A Case Report

Background: Delayed Post-Hypoxic Leukoencephalopathy (DPHL) is a demyelinating syndrome that typically occurs in the form of progressive acute encephalopathy from a few days to weeks after apparent recovery from a coma due to prolonged cerebral hypoxia. In this article, we present a case that developed spastic weakness of the lower extremities 3 months after hypoxic coma. The patient was eventually treated following a diagnosis of DPHL. Case Report: A 28-year-old patient presented with a history of hypoxic coma following methadone overdose 3 months prior to referral with progressive lower limb weakness. Neurological examination presented weakness of 4.5 lower limbs with hyperreflexia, clonus, and Babinski reflex. Imaging data indicated a broad symmetrical involvement of the logical hemisphere white matter with delayed leukoencephalopathy after hypoxia. Furthermore, all the tests requested for the patient provided data in the healthy range. Conclusion: DPHL is a unique clinical syndrome that requires high diagnostic suspicion along with additional laboratory and imaging findings. An essential point in the present report is the presentation of the spastic weakness of the lower extremities as a rare manifestation of DPHL.