Cranial MR findings in chronic toluene abuse by inhalation.
OBJECTIVE
Chronic abuse of toluene by inhalation causes variable white matter changes and thalamic hypointensity on T2-weighted MR images. The purpose of our study was to assess cranial MR findings in a large series of patients who chronically abuse toluene-containing solvents to investigate the factors causing the qualitative variability of white matter changes and thalamic hypointensity.


METHODS
We studied the neurologic signs, symptoms, and cranial MR findings in 41 patients who chronically abused thinner, a toluene-containing solvent. We classified white matter changes as diffuse or restricted. We tested the associations of the development of white matter lesions and thalamic hypointensity with patient age at onset of abuse and duration of abuse.


RESULTS
MR images revealed white matter lesions in 46% of the patients, atrophic dilatation of ventricles and sulci in 27%, and thalamic hypointensity in 20%. White matter changes were restricted in 53% and diffuse in 47%. The development of white matter changes and thalamic hypointensity were significantly associated with duration of abuse longer than 4 years (P <.05 and P <.01, respectively).


CONCLUSIONS
White matter changes seem to start in the deep periventricular white matter, and they spread into peripheral white matter, causing the loss of gray matter-white matter differentiation with continued toluene abuse. The deposition of iron due to demyelination and axonal loss is the most probable mechanism for the thalamic hypointensity found in solvent abusers.
Aydin
Kubilay
K
Department of Radiology, Istanbul University Medical School, Capa Hospital, Turkey.
Sencer
Serra
S
Demir
Turkay
T
Ogel
Kultekin
K
Tunaci
Atadan
A
Minareci
Ozenc
O
D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001921:Brain / Q000000981:diagnostic imaging* / Q000187:drug effects*; D001925:Brain Damage, Chronic / Q000139:chemically induced / Q000175:diagnosis; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011859:Radiography; D012720:Severity of Illness Index; D012997:Solvents / Q000009:adverse effects*; D015813:Substance Abuse Detection; D019966:Substance-Related Disorders / Q000175:diagnosis*; D013997:Time Factors; D014050:Toluene / Q000009:adverse effects*
D012997:Solvents; D014050:Toluene