Acute MRI changes in opiate-induced toxic leukoencephalopathy

Ung, Hoameng; Hess, Robert; Du, Fanny Huynh

doi:10.1136/bcr-2021-242762

Cited by 1 publication

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References 3 publications

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“…Prior research has indicated that various etiologies exist for causing acute TL including chemotherapeutic and immunosuppressive agents, illicit drug use, and environmental toxins. [4][5][6][7][8] Although the exact pathophysiology is still unknown, it is postulated that the neurotoxic properties of many of these causative agents result in white matter dysfunction leading to cytotoxic edema, demyelination, and axonal injury. A recent study by Özütemiz et al found that chemotherapeutic agents such as methotrexate, fludarabine, and 5-fluorouracil, are the most common cause of TL in a study of 101 patients while immunosuppressant therapy induced TL was less likely.…”

Section: Discussion/conclusionmentioning

confidence: 99%

Tacrolimus Induced Leukoencephalopathy and Stroke-Like Symptoms: Case Report

Dopke

Seblani

Mercer

et al. 2023

Child Neurology Open

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A 17-year-old female with sickle cell disease status post a recent stem cell transplant and on tacrolimus developed an acute expressive aphasia, dysphagia, and drooling. Brain MRI revealed diffuse restricted diffusion involving the bilateral corona radiata and areas of white matter in the right cerebral hemisphere most consistent with toxic leukoencephalopathy. Tacrolimus serum concentration was high at 19.3 ng/ml (ref 9-12 ng/ml) for which tacrolimus was discontinued. She was neurologically back at baseline 2 days later with the tacrolimus level improving to 8.2 ng/mL. Following discontinuation and the declining trend of her tacrolimus levels the patient returned to her neurologic baseline and was subsequently switched to mycophenolate mofetil for GVHD immunosuppression.

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