The Expanding Prominence of Toxic Leukoencephalopathy

Abstract

Toxic leukoencephalopathy (TL) is a disorder of brain white matter caused by exposure to leukotoxic agents. Magnetic resonance imaging (MRI) can readily identify this syndrome, and, together with diffusion tensor imaging, MRI continues to offer important insights into its nature. Since the first formal description of TL in 2001, many new leukotoxic disorders have been recognized, and the range of leukotoxins has expanded to include more therapeutic drugs, drugs of abuse, and environmental insults. While the understanding of pathophysiology remains incomplete, TL is increasingly common in clinical practice, and the potential long-term cognitive sequelae of toxic white matter injury merit attention.

Mimicking a Psychiatric Disorder: Heroin-Induced Leukoencephalopathy

“…TLE can cause mild deficits, including inattention, agitation, altered mentation, memory retrieval deficits, and visual hallucination, which usually suggest a psychotic disorder. Most of these symptoms are disabling [ 14 ]. On the contrary to the cortical gray matter cognitive disorders such as Alzheimer's disease, TLE usually presents with preserved language, hemiparesis, sensory deficits, and vision loss are less likely to be seen.…”

Mania as a possible complication of immunotherapy

“…Leukoencephalopathies are traditionally classified into genetic (so‐called leukodystrophies such as CADASIL) and acquired, the latter caused by a variety of agents (see Box ) …”

Full Recovery From Cocaine-Induced Toxic Leukoencephalopathy: Emphasizing the Role of Neuroinflammation and Brain Edema

“…Toxic leukoencephalopathy (TL) is suspected whenever a person develops neurobehavioral symptoms, and magnetic resonance imaging (MRI) reveals white matter lesions, especially if the lesions are widespread, confluent, and symmetric. 1,2 Diagnosing TL requires evidence of exposure to an agent with known white matter toxicity. It is also important to exclude other causes of leukoencephalopathy, such as autoimmune, inflammatory, or infectious white matter diseases, posterior reversible encephalopathy syndrome, chronic microvascular changes, and inherited disorders of myelin metabolism.…”

“…The clinical spectrum of TL is broad, with symptoms varying from inattention, forgetfulness, and personality change, to delirium and coma. 1,2 Clinical outcome is also variable. 5 Although death has been reported many times, survival is still the rule.…”