Toxic leukoencephalopathy

Changed by Ayush Goel, 7 Sep 2016

Updates to Article Attributes

Body was changed:

Show markup changes

Toxic leukoencephalopathy is an encephalopathy predominantly affecting white matter as a result of a toxic substance. The presentation can either be chronic or acute. In the acute phase, acute toxic leukoencephalopathy can have a characteristic and profound MR imaging appearance that is potentially reversible with therapy or removal of the offending agent.

Clinical presentation

The clinical presentation of toxic leukoencephalopathy is extremely variable, ranging from minor cognitive impairment, easily confused with psychiatric illnesses, to severe neurological dysfunction. The lack of imaging in patients with minimal or mild encephalopathic symptoms may account for why this entity may be underdiagnosed in the acute phase.

Pathology

Aetiology

There are numerous agents implicated in toxic leukoencephalopathy. These include:

antineoplastic drugs
- methotrexate (10% IV, 40% intrathecal): (C₂₀H₂₂N₈O₅)
- carmustine
- cisplatin
- cytarabine
- fluorouracil (5-FU)
- thiotepa
- interleukin-2 (IL-2)
- interferon alpha (INF alpha)
immunosuppresive drugs
- cyclosporin
- tacrolimus
antimicrobial agents
- amphotericin B
- hexachlorophene
drugs of abuse
- toluene (C₆H₅CH₃)
- ethanol (C₂H₅OH)
- methanol (CH₃OH)
- cocaine (C₁₇H₂₁NO₄)
- MDMA a.k.a. "ecstasy" (3,4-methylnedioxymethamphetamine)
- intravenous heroin
- inhaled heroin pyrolysate ("chasing the dragon")
- psilocybin
environmental toxins
- carbon monoxide (CO)
- arsenic (As)
- carbon tetrachloride (CCl₄)
cranial irradiation

Radiographic features

The findings are potentially reversible therapy or removal of the offending agent in the early phase.

MRI

FLAIR: : white matter abnormalities are typically confluent and symmetric, and may involve the corpus callosum as well, particularly the splenium
DWI: : white matter abnormalities are similar to FLAIR, typically confluent and symmetric, and may involve the corpus callosum as well, particularly the splenium

~~-FLAIR: white matter abnormalities are typically confluent and symmetric, and may involve the corpus callosum as well, particularly the splenium</li>~~
+FLAIR: white matter abnormalities are typically confluent and symmetric, and may involve the corpus callosum as well, particularly the splenium</li>
~~-DWI: white matter abnormalities are similar to FLAIR, typically confluent and symmetric, and may involve the corpus callosum as well, particularly the splenium</li>~~
+DWI: white matter abnormalities are similar to FLAIR, typically confluent and symmetric, and may involve the corpus callosum as well, particularly the splenium</li>

ADVERTISEMENT: Supporters see fewer/no ads

{"current_user":null,"inclusions":[{"imageId":6950,"studyId":6639,"caseSlug":"toxic-leukoencephalopathy-methotrexate-2","caption":"Case 1: from MTX and irradiation","thumbnail":"https://prod-images-static.radiopaedia.org/images/6950/c49f7cccc86b1c507a6a78b88971e9_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"probable"},{"imageId":7129,"studyId":6642,"caseSlug":"chasing-the-dragon-2","caption":"Case 2: from narcotics","thumbnail":"https://prod-images-static.radiopaedia.org/images/7129/3b9abf5d56b718c60f331353571963_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_unsubstantiated"},{"imageId":7148,"studyId":6642,"caseSlug":"chasing-the-dragon-2","caption":"Case 3: from narcotics","thumbnail":"https://prod-images-static.radiopaedia.org/images/7148/c9cc983572e25bb2a10c36d5440a2e_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_unsubstantiated"},{"imageId":27179570,"studyId":55486,"caseSlug":"acute-toxic-encephalopathy-1","caption":"Case 4: from 5-FU","thumbnail":"https://prod-images-static.radiopaedia.org/images/27179570/bfdc62be39b79c209c689d6655cfe5_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"probable"},{"imageId":21719732,"studyId":48353,"caseSlug":"toxic-leukoencephalopathy","caption":"Case 5","thumbnail":"https://prod-images-static.radiopaedia.org/images/21719732/2bbdc752d00d254c747a9e282c76a3_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_unsubstantiated"},{"imageId":52105112,"studyId":85617,"caseSlug":"methanol-induced-encephalopathy-1","caption":"Case 6: methanol-induced encephalopathy","thumbnail":"https://prod-images-static.radiopaedia.org/images/52105112/0563a73e788c57976114233a508922_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":53695408,"studyId":97602,"caseSlug":"toxic-encephalopathy","caption":"Case 7","thumbnail":"https://prod-images-static.radiopaedia.org/images/53695408/export--477558465_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"probable"},{"imageId":56619815,"studyId":115073,"caseSlug":"acute-methanol-poisoning","caption":"Case 8: acute methanol poisoning","thumbnail":"https://prod-images-static.radiopaedia.org/images/56619815/14_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"}],"ddx_inclusions":[],"lang":"us"}