# Chokehold with ‘rear naked choke’ and delayed post-hypoxic leukoencephalopathy: a new form of assault in Mexico City

## TL;DR

A man in Mexico City suffered brain damage after a strangulation attack, leading to a rare condition called delayed post-hypoxic leukoencephalopathy.

## Contribution

This case presents a new form of assault-related injury linking strangulation to delayed post-hypoxic leukoencephalopathy.

## Key findings

- Strangulation caused hypoxic-ischemic encephalopathy followed by delayed post-hypoxic leukoencephalopathy.
- The patient developed aphasia, dysphagia, and progressive dementia after the attack.
- Brain imaging and biopsy showed ischemic damage and reactive gliosis consistent with DPHL.

## Abstract

In Mexico City, a 49-year-old man underwent strangulation, which led to hypoxic-ischemic encephalopathy (HIE) and subsequently to delayed post-hypoxic leukoencephalopathy (DPHL), a rare demyelinating condition. Following the attack, he exhibited aphasia, dysphagia, and other neuropsychiatric symptoms that progressed to dementia. Imaging and brain biopsy analyses disclosed extensive ischemic damage and reactive gliosis. This case underscores the link between strangulation, acute HIE, and the subsequent development of DPHL, as well as an interpretation of the physiological implications of DPHL due to strangulation.