两例致死性中毒性白质脑病患者的临床、影像学和尸检表现

Fatal toxic leukoencephalopathy: Clinical, radiological, and necropsy findings in two patients

Background: Toxic leukoencephalopathy has been described with inhalation and intravenous consumption of heroin and cocaine. The clinical picture varies widel y but the imaging and histological features are characteristic. Magnetic resonan ce imaging (MRI) typically reveals diffuse bihemispheric white matter lesions. H istologically there is extensive spongiform degeneration of the cerebral white m atter. Objective: To report two cases of fatal toxin associated leukoencephalopa thy, along with detailed imaging and neuropathological studies. Results: MRI rev ealed diffuse white matter changes. Histologically there was widespread confluen t vacuolar degeneration of the deep white matter. In both cases, there was spari ng of the brain stem and cerebellar white matter. There was evidence of severe a nd extensive axonal injury. Conclusions: This pattern of radiological involvemen t and histological findings has not previously been reported and may reflect the presence of a yet unidentified impurity.