摘要Rationale: Delayed post-hypoxic leukoencephalopathy (DPHL) is usually an overlooked condition, which arises as a result of a multitude of reversible and irreversible conditions. Patient's Concern: A 50-year-old female with a history of epilepsy, who developed DPHL 12 days after respiratory failure secondary to barbiturate toxicity. Diagnosis: DPHL on magnetic resonance imaging of the brain. Interventions: Mechanical ventilation was initiated for respiratory failure and hemodialysis for barbiturate toxicity. Outcomes: The patient developed akinetic mutism due to infirmity and had a residual disability, which led to permanent dependency. Lessons: The diagnosis of DPHL is often delayed or missed, given the rarity of this condition and its inconsistent clinical symptomatology. Diagnostic delay can be avoided by early recognition of the classical "delayed onset" symptoms.