Multifocal inflammatory leukoencephalopathy: use of thallium-201 SPECT and proton MRS.
In a patient receiving 5-fluorouracil and levamisole, neurologic deficits suggest the cerebral demyelinating syndrome as a differential diagnosis. The authors report a patient diagnosed as multifocal inflammatory leukoencephalopathy for which thallium-201 (201Tl) single photon emission computed tomography (SPECT) and proton magnetic resonance spectroscopy (MRS) were employed as noninvasive diagnostic tools. 201Tl SPECT study was negative and proton MRS showed an increase of choline and lactate and well preserved N-acetylaspartate. These findings support histopathologic findings of multifocal inflammatory leukoencephalopathy revealing demyelination with relative axonal sparing in the patient.
Hwang
Yang Ha
YH
Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Korea.
Suh
Chung Kyu
CK
Park
Sung Pa
SP
D000276:Adjuvants, Immunologic / Q000009:adverse effects / Q000627:therapeutic use; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects / Q000627:therapeutic use; D001224:Aspartic Acid / Q000031:analogs & derivatives* / Q000378:metabolism; D001369:Axons / Q000473:pathology; D001706:Biopsy; D001921:Brain / Q000473:pathology; D001932:Brain Neoplasms / Q000556:secondary; D002794:Choline / Q000378:metabolism; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000473:pathology; D003937:Diagnosis, Differential; D005472:Fluorouracil / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D019344:Lactic Acid / Q000378:metabolism; D007968:Leukoencephalopathy, Progressive Multifocal / Q000175:diagnosis* / Q000209:etiology; D007978:Levamisole / Q000009:adverse effects / Q000627:therapeutic use; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
D000276:Adjuvants, Immunologic; D000964:Antimetabolites, Antineoplastic; D013794:Thallium Radioisotopes; D007978:Levamisole; D001224:Aspartic Acid; D019344:Lactic Acid; C000179:N-acetylaspartate; D002794:Choline; D005472:Fluorouracil