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Published on: October 28, 2022
Imaging features of acquired pediatric metabolic and toxic white matter disorders
Alexander Filatov1, Sarah Milla, Karuna Shekdar
1From the *Department of Radiology, NYU Langone Medical Center, New York, NY; †Department of Radiology, Children's Hospital of Philadelphia, PA; and ‡Department of Radiology, Clinics IRM, Clinica de Diagnóstico por Imagen and Multi-Imagem, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
Insights
Acquired white matter abnormalities in children stem from metabolic and toxic causes. Early recognition of conditions like neonatal hypoglycemia and central pontine myelinolysis (CPM) is crucial for limiting or reversing brain damage.
Area of Science:
- Pediatric neurology
- Neuroimaging
- Toxicology
Background:
- Acquired white matter abnormalities in children present a diverse range of etiologies.
- Metabolic and toxic factors are significant contributors to pediatric white matter disorders.
- Prompt diagnosis and intervention are critical for managing cerebral damage.
Purpose of the Study:
- To review the clinical, pathophysiological, and imaging features of acquired metabolic and toxic leukoencephalopathies in pediatric patients.
- To emphasize the importance of recognizing specific metabolic disorders and toxic exposures.
- To differentiate prognoses based on the etiology of white matter toxicity.
Main Methods:
- Literature review focusing on acquired metabolic and toxic leukoencephalopathies in children.
- Analysis of clinical presentations, underlying mechanisms, and characteristic imaging findings.
- Discussion of differential diagnoses and prognostic implications.
Main Results:
- Neonatal hypoglycemia, nonketotic hyperglycemia, hyperammonemia, hepatic encephalopathy, and central pontine myelinolysis (CPM) are key metabolic etiologies.
- Toxic leukoencephalopathies include iatrogenic agents, household substances, and recreational drugs.
- Recreational drug-induced white matter toxicity often has a poorer prognosis compared to medication-induced cases.
Conclusions:
- Accurate identification of acquired white matter abnormalities in children is essential for timely management.
- Understanding the specific metabolic and toxic causes guides therapeutic strategies.
- Early intervention can significantly impact outcomes and potentially reverse neurological deficits.
Abstract:
Acquired white matter abnormalities in children may be due to a broad spectrum of disorders, with the most significant related to metabolic and toxic etiologies. Recognition of the imaging appearance of neonatal hypoglycemia, nonketotic hyperglycemia, hyperammonemia, hepatic encephalopathy, and central pontine myelinolysis (CPM) is essential because prompt correction of the underlying metabolic abnormality may limit and, in some cases, reverse the cerebral damage. Toxic leukoencephalopathies encompass disorders caused by iatrogenic administration of pharmacologic agents and radiation therapy, poisoning by household substances, and recreational drug use. Although medication-induced leukoencephalopathies often show a propensity for reversibility of clinical and radiologic findings upon discontinuation of the offending substance, recreational drugs may cause white matter toxicity that often portends a poorer prognosis. Our discussion focuses on the clinical aspects, pathophysiological mechanisms, and imaging features of commonly encountered acquired metabolic and toxic leukoencephalopathies in the pediatric population.
