Toxic leukoencephalopathy

Case contributed by Dr Abdallah Khateeb

Presentation

Known case of NSCLC with brain metastasis on CT scan.

Patient Data

Age: 57 years old
Gender: Male
MRI

First MRI image

Multiple intra-axial nodules with significant surrounding vasogenic edema most consistent with metastasis.

The patient received intra-thecal chemotherapy for metastasis. Presenting with decreased level of consciousness.

CT

Five months from receiving chemotherapy

The supratentorial white matter is diffusely hypodense, with exaggeration of the grey white matter differentiation. No mass effect, so edema is less likely.

Asymmetry of the brainstem with expansion? of the right side.

MRI

Most recent MRI. Five months from receiving chemotherapy.

Diffuse bilateral, confluent and symmetrical high signal of white matter, with obvious sparing of the subcortical U fibers and corpus callosum.

The right side of brainstem is expanded with abnormal signal as well.

Right frontal low signal / blooming focus which is explained by the patient's previous MRI (see below). 

A small diffusion restricting focus at the right frontal lobe which was overlooked on T2 and FLAIR; acute infarction.

Case Discussion

The intrathecal chemotherapy and the development of such white matter changes in a relatively short time frame are most consistent with toxic leukoencephalopathy

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Case information

rID: 44608
Case created: 28th Apr 2016
Last edited: 6th Jul 2016
Inclusion in quiz mode: Included

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