Abnormal behaviour, nystagmus and truncal ataxia.
MRI Brain (single image)
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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.
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.
Case credit: Dr Laughlin Dawes, Dr Constantine Phatouros
- 1. Aydin K, Sencer S, Demir T et-al. Cranial MR findings in chronic toluene abuse by inhalation. AJNR Am J Neuroradiol. 2002;23 (7): 1173-9. AJNR Am J Neuroradiol (full text) - Pubmed citation
- 2. Autti T, Joensuu R, Aberg L. Decreased T2 signal in the thalami may be a sign of lysosomal storage disease. Neuroradiology. 2007;49 (7): 571-8. doi:10.1007/s00234-007-0220-6 - Pubmed citation