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To the Editor:
Chalela et al.1 reported early white matter injury in anoxic–ischemic encephalopathy (AIE) in seven relatively young (median age 31.5 years) patients. Causes of AIE were varied, and included patients with cardiac arrest, carbon monoxide intoxication, or drug abuse. They suggested that the high fatality rate (5/7) might indicate that anoxic white matter injury carries a worse prognosis.1
To determine whether demyelination occurs in AIE and could eventually be taken as an initial prognostic factor, we studied prospectively 27 patients with AIE (myocardial infarction or ventricular arrhythmias, 85%; respiratory failure or arrest, 15%). Serum level of galactosylceramide, a major component of myelin, has been proved to be a reliable index of demyelination.2 Galactosylceramide, undetectable in normal individuals, is detected in sera of patients with MS, stroke, or intracranial …
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