Presentation
Dizziness.
Patient Data
Bilateral basal ganglia, thalami and centrum semiovale abnormal signal eliciting high signal on T2 and subtle high signal on FLAIR. No diffusion restriction.
Cerebral arterioleuckoencephalopathy.
Right pontine tiny chronic hemorrhagic focus.
Brain atrophic changes.
Case Discussion
The bilateral basal ganglia and thalamic high signal were suggestive of toxic/metabolic leukoencephalopathy. The laboratory workup revealed normal hepatic and renal functions as well as normal random glucose levels. Upon further questioning, the patient's sister mentioned that she complained of severe depression and had suicidal attempt using a small amount of rat poison one day before she started complaining.
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.
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