title: Toxic leukoencephalopathy in the intensive care unit.
abstract: In this article, we report two cases of acute toxic leukoencephalopathy to highlight this acute clinicoradiological syndrome as an important, although uncommon, consideration in the undifferentiated comatose patient who fails to wake following drug overdose or has unexplained neurology with a history of drug exposure. We then review the current literature and discuss potential differential diagnoses in this setting, along with proposed treatments for this condition. The cases presented demonstrate a more fulminant onset than previously well-defined acute toxic leukoencephalopathy subtypes and highlight the prognostic importance of magnetic resonance imaging in diagnosing a condition from which significant functional recovery seems possible.
authors.affiliation: Intensive Care Unit, Townsville Hospital, Douglas, Queensland.
authors.forename: A L
authors.initials: AL
authors.lastname: Holyoak
authors.affiliation: Intensive Care Unit, Townsville Hospital, Douglas, Queensland.
authors.forename: M J
authors.initials: MJ
authors.lastname: Trout
authors.affiliation: Department of Neurology, Townsville Hospital, Douglas, Queensland.
authors.forename: R P
authors.initials: RP
authors.lastname: White
authors.affiliation: Department of Radiology, Townsville Hospital, Douglas, Queensland.
authors.forename: S
authors.initials: S
authors.lastname: Prematuranga
authors.affiliation: Intensive Care Unit, Townsville Hospital, Douglas, Queensland.
authors.forename: S
authors.initials: S
authors.lastname: Senthuran
mesh_terms: D000328:Adult; D000662:Amphetamines / Q000506:poisoning*; D000929:Antidepressive Agents, Tricyclic / Q000506:poisoning; D014150:Antipsychotic Agents / Q000506:poisoning; D001205:Ascorbic Acid / Q000627:therapeutic use; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D002998:Clonazepam / Q000506:poisoning*; D003937:Diagnosis, Differential; D003987:Dibenzothiazepines / Q000506:poisoning; D017809:Fatal Outcome; D006801:Humans; D007362:Intensive Care Units; D056784:Leukoencephalopathies / Q000139:chemically induced* / Q000188:drug therapy; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008803:Mianserin / Q000031:analogs & derivatives / Q000506:poisoning; D000078785:Mirtazapine; D010098:Oxycodone / Q000506:poisoning*; D011782:Quadriplegia / Q000139:chemically induced*; D000069348:Quetiapine Fumarate; D012997:Solvents / Q000506:poisoning; D014057:Tomography, X-Ray Computed / Q000379:methods; D014451:Ubiquinone / Q000031:analogs & derivatives / Q000627:therapeutic use; D014810:Vitamin E / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000662:Amphetamines; D000929:Antidepressive Agents, Tricyclic; D014150:Antipsychotic Agents; D003987:Dibenzothiazepines; D012997:Solvents; D014451:Ubiquinone; D014810:Vitamin E; D008803:Mianserin; D000069348:Quetiapine Fumarate; D002998:Clonazepam; D000078785:Mirtazapine; D010098:Oxycodone; C024989:coenzyme Q10; D001205:Ascorbic Acid
keywords: coma; drug toxicity; intensive care neurology; toxic leukoencephalopathy