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