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detected using Gram stain, ink stain, acid-fast stain, growing rapidly, particularly among early adolescents
or Mycobacterium tuberculosis culture. DNA-based experimenting with volatile substances or inhalants and
tests for cytomegalovirus, Epstein-Barr virus, and workers in developing countries who lack occupational
herpes simplex virus were all negative. Chest X-rays, protection. After inhalation, toluene is quickly absorbed
electrocardiogram, and ultrasonography of the by the lungs, then enters the brain due to its high
heart and abdomen detected nothing unordinary; lipophilicity and accumulates. Following metabolization
however, a slight abnormality was observed on the in the liver, it is excreted by the kidneys mostly in the
electroencephalogram. Most importantly, cranial form of hippuric acid. Chronic toluene inhalation
[2]
MRI of the patient showed diffuse cerebral white primarily damages the central nervous system (CNS),
matter hyperintensity [Figure 1], which resembled a especially the white matter, and causes toluene-induced
characteristic “sunflower-like” change in T2-weighted leukoencephalopathy and psychosis. [2-4] Although
images. The patient was diagnosed with toluene-induced cognitive impairment is the most prominent symptom,
leukoencephalopathy according to the “Diagnostic additional clinical manifestations may differ depending
Criteria of Occupational Acute Toluene Poisoning” on the brain regions that are affected, including
of China. After 2 weeks of treatment with mannitol, ataxia, tremors, psychiatric disorders, Parkinson’s
[5]
hyperbaric oxygenation, and neurotrophic medicine disease, and temporal lobe epilepsy. The diagnosis
including intravenous ganglioside GM1, Vitamins of toluene-induced leukoencephalopathy is primarily
B12, B1, and B6, huperzine-A tablets, and Oxiracetam based upon the history of contact with toluene, clinical
capsules, the patient’s symptoms were mostly resolved, manifestations caused by damage to the nervous
with an MMSE score of 26 on discharge. system, and exclusion of other medical conditions
with similar symptoms. Neuroimaging and medical
DISCUSSION history are crucial to the diagnosis of toluene-induced
leukoencephalopathy, as opposed to other types of
As a common component of experimental organic encephalopathy such as heroin-related encephalopathy
solvents and industrial products such as glues, inks, or hypoxic-ischemic encephalopathy.
paints, and paint thinners, toluene is a ubiquitous
solvent. The number of people suffering from Several studies have focused on the characteristic
medical conditions caused by toluene exposure is features of toluene-induced leukoencephalopathy

a b

c d
Figure 1: Magnetic resonance imaging shows symmetrical periventricular white matter hyperintensity (arrows) in axial T2-weighted (b), fluid-attenuated inversion
recovery (c), and diffusion-weighted imaging (d) images, along with corresponding changes in T1-weighted images (a). The characteristic “sunflower-like” change
is readily apparent, particularly in the T2‑weighted image. Increased signal is also visible in the cerebellar dentate nuclei (arrowheads). Gray matter‑white matter
differentiation is preserved

Neuroimmunol Neuroinflammation | Volume 1 | Issue 2 | September 2014 93