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Acute Toxic Leukoencephalopathy: Etiologies, Imaging Findings, and Outcomes in 101 Patients

C Özütemiz1, S K Roshan2, N J Kroll3

  • 1From the Department of Radiology (C.Ö., S.K.R., J.C.B., J.B.R., A.M.M.) ozutemiz@umn.edu.

AJNR. American Journal of Neuroradiology
|January 26, 2019
PubMed
Abstract

Insights

Acute toxic leukoencephalopathy (ATL) outcomes vary by cause, with chemotherapy and opiate-related cases showing worse prognoses. Imaging severity weakly correlates with outcomes, but stronger in chemotherapy and opiate groups.

Area of Science:

  • Neurology
  • Radiology
  • Toxicology

Background:

  • Prior studies on acute toxic leukoencephalopathy (ATL) are limited in scope and preliminary.
  • Understanding the diverse etiologies and their impact on imaging and clinical outcomes is crucial.

Purpose of the Study:

  • To evaluate the various etiologies of acute toxic leukoencephalopathy (ATL).
  • To compare differences in imaging severity and clinical outcomes across different ATL etiologies.

Main Methods:

  • Retrospective review of 101 patients with suspected ATL over 15 years.
  • Inclusion criteria: MRI within 3 weeks of presentation with DWI and FLAIR sequences.
  • Imaging severity graded using a standardized score; clinical outcomes assessed via mRS and ATLOS scores; etiologic subgroups (n>6) statistically compared.

Main Results:

  • Four main etiologic subgroups identified: chemotherapy (n=35), opiates (n=19), acute hepatic encephalopathy (n=14), and immunosuppressants (n=11).
  • Significant differences in imaging severity and outcomes were observed among subgroups (P=.003-.032), with immunosuppressant-related ATL differing notably from chemotherapy and opiate-related ATL.
  • Chemotherapy and opiate-related ATL subgroups showed the worst outcomes, with imaging severity weakly correlating to outcome overall, but stronger in these two groups.

Conclusions:

  • Clinical outcomes of ATL are etiology-dependent, with poorer outcomes associated with chemotherapeutic and opiate exposure.
  • Uremia may act as a predisposing or exacerbating factor in ATL.
  • ATL resolved in 36% of patients, with 23% experiencing severe outcomes (coma or death).

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