A 50 year old male with a PMH of HTN, DM, polysubstance abuse (heroin, K2), and CAD presented to an outside hospital with dyspnea and chest pain along with an elevated troponin. He was transferred to our institution for cardiac catheterization. Upon arrival he suffered PEA arrest. ROSC was obtained after 6 minutes. The patient did well for approximately three days after this event.

There is ample literature on the phenomenon of delayed post-hypoxic leukoencephalopathy where there is demyelination after days to weeks following a period of cerebral hypoperfusion. Typically, in these cases, there are diffuse and confluent white matter changes on MRI with restricted diffusion. This picture significantly differs from our patient. This is the first report to our knowledge where hypoxic-ischemic encephalopathy involving mostly grey matter has presented in such a delayed fashion. Documentation of this phenomenon is novel, and crucial in preventing unnecessary workup of neurologic dysfunction following a hypoxic event.