Presentation
Known case of NSCLC with brain metastasis on CT scan.
Patient Data
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.
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.
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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