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Reversible hypoxic brain injury: the penumbra conundrum of Grinker
  1. Shiva Balan1,
  2. Kartik Gupta1,
  3. Parthiban Balasundaram2 and
  4. Ranveer Jadon1
  1. 1 Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
  2. 2 Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
  1. Correspondence to Dr Shiva Balan, shivfrcs{at}


A female patient, aged 61 years, presented to us with a 3-day history of fever and altered sensorium. She was discharged from another hospital 1 week back where she was admitted for community-acquired pneumonia. She was put on mechanical ventilation for threatened airway and her magnetic resonance brain imaging showed evidence of delayed posthypoxic leucoencephalopathy, also known as Grinker’s myelinopathy. She was discharged 1 month later, on room air with a tracheostomy tube in situ. On follow-up after 5 months, she was ambulating with support and carried out activities of daily living independently.

  • neuroimaging
  • clinical neurophysiology

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  • Contributors SB, KG and RJ were part of the team that provided clinical care. PB helped with neuroimaging and wrote the relevant part of the case report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Next of kin consent obtained.