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Case Report

Toluene‑induced leukoencephalopathy with

characteristic magnetic resonance imaging

findings

Fan Zeng, Heng Yang, Hua‑Dong Zhou, Yan‑Jiang Wang
Department of Neurology and Center for Clinical Neuroscience, Daping Hospital and Institute of Field Surgery,
Third Military Medical University, Chongqing 400042, China.

ABSTRA CT

Toluene‑induced leukoencephalopathy is a frequently seen medical condition worldwide; however the lack of specific clinical
manifestations and laboratory tests makes it difficult to diagnose. Neuroimaging and medical history are often crucial to diagnosis of
this disorder. In this report, a case is presented of a patient suffering from toluene‑induced leukoencephalopathy with deteriorating
cognition impairment and characteristic magnetic resonance imaging (MRI) findings, typified by a “sunflower‑like” change in
T2‑weighted imaging. In addition, the pharmacokinetic properties of toluene are reviewed, as well as the clinical manifestations,
typical MRI findings, neuropathology, possible mechanism, and treatment of toluene‑induced leukoencephalopathy.

Key words: Leukoencephalopathy, neuroimaging, occupational protection, toluene

INTRODUCTION over a period of 1-month with gradual deterioration.
The patient had been a shoemaker for 3 years and
Leukoencephalopathy is a broad term used to describe had daily contact with toluene-containing glue for
a number of leukodystrophy-like diseases. Impairment around 10 h a day. The patient had no history of
of the nervous system due to toluene inhalation is a vascular risk factors such as hypertension, diabetes,
frequent source of toxin-induced leukoencephalopathy. smoking, or alcohol, and there was no family
Reported symptoms are mostly nonspecific, such history of similar symptoms. No other features of
as headache, dizziness, and impaired cognition. note were present in the patient’s medical history.
[1]
Toluene-induced leukoencephalopathy may, therefore, Physical and neuropsychological examination
go undiagnosed by doctors and neurologists, especially revealed memory decline, impaired calculation, and
in patients without hematopoietic system impairment. visuospatial impairment, with a mini-mental state
We present here an interesting case of toluene-induced examination (MMSE) score of 23. Blood tests showed
leukoencephalopathy with characteristic magnetic increased levels of total cholesterol (6.7 mmol/L) and
resonance imaging (MRI) findings. triglycerides (3.6 mmol/L). Blood cell counts, fasting
glucose levels, liver and renal function, and levels of
CASE REPORT folic acid, vitamin B , and ferritin were all normal. The
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possibility of syphilis or human immunodeficiency
A 44-year-old male patient presented to the clinic with virus infection was also excluded. Intracranial pressure
dizziness, headache located primarily in the occipital was 180 mmH O as measured by lumbar puncture;
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region, memory decline, and a dull response, occurring however no abnormalities were observed upon
further examination of the cerebrospinal fluid. Levels
Access this article online of protein (0.37 g/L), glucose levels (3.67 mmol/L),
Quick Response Code: chloridion (124.4 mmol/L), aspartate transaminase
Website: (15.2 U/L), lactate dehydrogenase (15.9 U/L) and
www.nnjournal.net
adenosine deaminase (15.18 U/L) were all normal.
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DOI: The total cell count was 0.008 × 10 /L, and the white
10.4103/2347-8659.139721 blood cell count was 0.001 × 10 /L. Pandy’s test was
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negative. No evidence of bacterial infection was
Corresponding Author: Prof. Yan‑Jiang Wang, Department of Neurology and Center for Neuroscience, Daping Hospital and
Institute of Field Surgery, Third Military Medical University, 10, Changjiang Branch Road, Yuzhong District, Chongqing 400042,
China. E‑mail: yanjiang_wang@tmmu.edu.cn

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