Singh VİVEK, Tomar VAİSHALİ, Kumar ALOK, Phadke RAJENDRA V.

Acute leucoencephalopathy with restriction of diffusion-a case report

Abstract. Acute white matter insult in a non traumatic, non ischemic background has been recently identified in certain clinical situations. Named toxic leukoencephalopathy, it may be caused by exposure to a wide variety of agents, including cranial irradiation, therapeutic agents, drugs of abuse, and environmental toxins. Extensive central white matter restriction of diffusion in the absence of significant T2 or Fluid-attenuated inversion recovery (FLAIR) abnormality is the imaging hallmark on Magnetic Resonance Imaging (MRI). Reversibility of the symptoms after the withdrawal of toxin has been shown in a few reports. We present one such case with reversal of changes on MRI and clinical improvement. Key words: ADEM, intramyelinic edema, PRES, toxic leukoencephalopathy

Keywords:

ADEM, intramyelinic edema, PRES, toxic leukoencephalopathy,

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Filley CM, Kleinschmidt-DeMasters BK. Toxic leukoencephalopathy. N Engl J Med 2001; 345: 425- 432.
McKinney AM, Kieffer SA, Paylor RT, et al. Acute toxic leukoencephalopathy: Potential for reversibility clinically and on MRI with diffusion-weighted and FLAIR imaging. AJR Am J Roentgenol 2009; 193: 192-206.
Schaefer PW, Grant PE, Gonzalez RG. Diffusion- weighted MR imaging of the brain. Radiology 2000; 217:331-345.
Nomura Y, Sakuma H, Takeda K, et al. Diffusional anisotropy of the human brain assessed with diffusion-weighted MR: relation with normal brain development and aging. AJNR Am J Neuroradiol 1994; 15: 231-238.
Wimberger DM, Roberts TP, Barkovich AJ, et al. Identification of “premyelination” by diffusion- weighted MRI. J Comput Assist Tomogr 1995; 19: 28- 33.
McKinney AM, Short J, Truwit CL, et al. Posterior reversible encephalopathy syndrome: Incidence of atypical regions of involvement and imaging findings. AJR Am J Roentgenol 2007; 189: 904-912.
Sivasubramanian S, Moorthy S, Sreekumar K, Kannan RR. Diffusion-weighted magnetic resonance imaging in acute reversible toxic leukoencephalopathy: A report of two cases. Indian J Radiol Imaging 2010; 20: 192-194.
Gallucci M, Limbucci N, Paonessa A, Caranci F. Reversible focal splenial lesions. Neuroradiology 2007; 49: 541-544.
Moritani T, Smoker WR, Sato Y, Numaguchi Y, Westesson PL. Diffusion-weighted imaging of acute excitotoxic brain injury. AJNR Am J Neuroradiol 2005; 26: 216-228.
Wani AA, Phadke R, Behari S, et al. Role of
diffusion-weighted MRG in predicting outcome in subarachnoid hemorrhage due to anterior communicating artery aneurysms. Turk Neurosurg 2008; 18: 10-16.