Presentation
Abnormal behavior, nystagmus and truncal ataxia.
Patient Data
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 fibers. 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 ceruloplasmin deficiency (Wilson's disease) and lysosomal storage disorders 2.
Case credit: Dr Laughlin Dawes, Dr Constantine Phatouros
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