Solvent abuse

Case contributed by A.Prof Frank Gaillard

Presentation

Abnormal behaviour, nystagmus and truncal ataxia.

Patient Data

Age: 22 years
Gender: Male

MRI Brain (single image)

Modality: MRI

The single axial T2-weighted MR image demonstrates reduced signal in the thalami, and increased signal in the posterior limbs of the internal capsules. Cortical grey-white differentiation is reduced. Other images (not shown) showed increased signal elsewhere in the corticospinal tracts, in the middle cerebellar peduncles and in the pontine crossing fibres. The dentate nuclei are of low signal.

Case Discussion

This case illustrates MR changes consistent with heavy solvent abuse, of which the patient has a long history.

MR changes in toluene abuse by inhalation have been described and include: white matter lesions (focal and diffuse), cerebral atrophy, and thalamic hypointensity. The mechanism of thalamic hypointensity may be iron deposition and axonal loss.

Other causes of thalamic hypointensity to consider include metabolic disorders such as caeruloplasmin deficiency (Wilson's disease) and lysosomal storage disorders 2.

Case credit: Dr Laughlin Dawes, Dr Constantine Phatouros

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Case Information

rID: 17295
Case created: 2nd Apr 2012
Last edited: 7th Feb 2016
Inclusion in quiz mode: Included

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