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Alexander M Mckinney - One of the best experts on this subject based on the ideXlab platform.
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pediatric acute Toxic Leukoencephalopathy prediction of the clinical outcome by flair and dwi for various etiologies
American Journal of Neuroradiology, 2020Co-Authors: Kerem Ozturk, Jeffrey B Rykken, Alexander M MckinneyAbstract:BACKGROUND AND PURPOSE: Pediatric acute Toxic Leukoencephalopathy is a clinicoradiologic entity comprising various etiologies. This study aimed to identify the MR imaging appearance of pediatric acute Toxic Leukoencephalopathy from various etiologies and determine whether the etiology correlates with clinical outcome. MATERIALS AND METHODS: We retrospectively reviewed the electronic records of patients with pediatric acute Toxic Leukoencephalopathy younger than 19 years of age who had MR imaging within RESULTS: Of 22 children, 3 were excluded due to a nonToxic cause or incomplete examination. Regarding the included 19 children (mean age, 13 years), the etiologies of pediatric acute Toxic Leukoencephalopathy were the following: methotrexate (n = 6), bone marrow transplantation (n = 4), fludarabine (n = 3), cytarabine (n = 1), carboplatin (n = 1), vincristine (n = 1), cyclosporine (n = 1), uremia (n = 1), and bevacizumab (n = 1). Three subgroups were analyzed (chemotherapy, n = 12; immunosuppression, n = 5; others, n = 2). There was a strong correlation of FLAIR (r = 0.773, P CONCLUSIONS: The DWI and FLAIR severity scores appear highly prognostic, whereas percentage ADC reduction is moderately prognostic for clinical outcomes in pediatric acute Toxic Leukoencephalopathy. Immunosuppressive pediatric acute Toxic Leukoencephalopathy tends toward favorable outcomes, and fludarabine tends toward worse outcomes.
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acute Toxic Leukoencephalopathy etiologies imaging findings and outcomes in 101 patients
American Journal of Neuroradiology, 2019Co-Authors: Can Ozutemiz, Jeffrey B Rykken, Sara Khanipour Roshan, Neil J Kroll, John C Benson, Mark Oswood, Lei Zhang, Alexander M MckinneyAbstract:BACKGROUND AND PURPOSE: Prior studies regarding acute Toxic Leukoencephalopathy (ATL) are either small, or preliminary. Our aim was to evaluate etiologies of and differences in imaging severity and outcomes among various etiologies of ATL. MATERIALS AND METHODS: MRIs of patients with suspected ATL over 15 years were retrospectively reviewed; inclusion criteria were: MRI 6 patients were statistically compared. RESULTS: Of 101 included patients, the 4 subgroups of n > 6 were the following: chemotherapy (n = 35), opiates (n = 19), acute hepatic encephalopathy (n = 14), and immunosuppressants (n = 11). Other causes (n = 22 total) notably included carbon monoxide (n = 3) metronidazole (n = 2), and uremia (n = 1). The mean DWI/FLAIR severity scores were 2.6/2.3, 3.3/3.3, 2.1/2.1 and 2.0/2.5 for chemotherapeutics, opiates, AHE and immunosuppressants, respectively, with significant differences in both imaging severity and outcome (P = .003–.032) among subgroups, particularly immunosuppressant versus chemotherapy-related ATL and immunosuppressants versus opiates (P = .004–.032) related ATL. DWI and FLAIR severity weakly correlated with outcome (ρ = 0.289–.349, P CONCLUSIONS: Clinical outcomes of ATL vary on the basis of etiology, being worse in chemotherapeutic- and opiate-related ATL. Uremia may be a predisposing or exacerbating factor.
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choices an acronym to aid in delineating potential causes of non metabolic non infectious acute Toxic Leukoencephalopathy
European Journal of Radiology Open, 2019Co-Authors: Yasemin Koksel, Jeffrey B Rykken, Can Ozutemiz, Mark Oswood, Frederick Ott, Zuzan Cayci, Alexander M MckinneyAbstract:Abstract Purpose To describe non-metabolic, non-infectious etiologies of acute Toxic Leukoencephalopathy (ATL) on DWI MRI, and provide a useful acronym to remember them. Material and Methods Our PACS archive was reviewed, yielding 185 patients with suspected ATL per MRI reports and clinical follow up; infectious or metabolic causes were excluded. Result/Discussion The 87 included non-infectious, non-metabolic ATL patients' etiologies are represented by the acronym 'CHOICES': chemotherapy ('C',n = 34); heroin-induced ('H',n = 6), opioid analogues ('O',n = 14); immunosuppressant ('I',n = 11) or imidazole (n = 2); cocaine ('C',n = 1); environmental or ethanol abuse ('E',n = 5), splenial lesions ('S',n = 9), and 'other' (n = 5). Conclusion The "CHOICES" acronym delineates various Toxic etiologies of ATL.
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concomitant acute Toxic Leukoencephalopathy and posterior reversible encephalopathy syndrome
Journal of Neuroimaging, 2018Co-Authors: Can Ozutemiz, Jeffrey B Rykken, Neil J Kroll, Sarah Khanipour Roshan, Frederick Ott, Alexander M MckinneyAbstract:BACKGROUND AND PURPOSE Posterior reversible encephalopathy syndrome (PRES) and acute Toxic Leukoencephalopathy (ATL) are both potentially reversible clinicoradiologic entities. Although their magnetic resonance imaging (MRI) findings differ, rarely both may occur simultaneously in acutely encephalopathic patients. Our aim was to determine the incidence and causes of concomitant "ATL-PRES." METHODS Retrospective search of suspected acutely encephalopathic adults since 1998 throughout our picture archiving and communication system revealed 167 patients with PRES and 106 patients with ATL. Images of these patients were retrospectively evaluated by two neuroradiologists and a fellow to identify the cases which carry both features of PRES and ATL. Imaging findings were scored based on previously reported scoring system as mild, moderate, and severe. The clinical outcome of the patients was determined according to the modified Rankin scale. RESULTS Our search revealed a series of 6 patients (%2.2) in 273 patients who presented acutely with either encephalopathy or seizures, caused by various etiologies, including immunosuppression following transplantation (n = 2), hypertensive crisis (n = 2), chemotherapy (n = 1), and sepsis (n = 1). MRI demonstrated findings consistent with both PRES and ATL simultaneously on FLAIR and diffusion weighted imaging. Severity of imaging findings of concomitant "ATL-PRES" was concordant with each other (rho ≈ 1.0, P < .00001), and each patient eventually returned to clinical baseline. This finding, along with their similar etiologies, raises the possibility of an underlying common pathophysiologic thread, perhaps being endothelial Toxicity. CONCLUSIONS Concomitant "ATL-PRES" was found in 2.2% of the patients in a large cohort of ATL and PRES. Etiologies varied. Clinical symptoms and MRI findings were potentially reversible.
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Toxic Leukoencephalopathy following fludarabine associated hematopoietic cell transplantation
Biology of Blood and Marrow Transplantation, 2011Co-Authors: Amer Beitinjaneh, Alexander M Mckinney, Qing Cao, Daniel J WeisdorfAbstract:Toxic Leukoencephalopathy has been more thoroughly investigated during the last decade because of the advance of magnetic resonance imaging (MRI) techniques. We analyzed fludarabine (Flu)-associated hematopoietic cell transplantation (HCT), resulting in severe Leukoencephalopathy (n = 39/1596, 2.4%), and describe 3 clinical syndromes with unique clinical and radiographic characteristics. Posterior reversible encephalopathy syndrome (PRES) presents predominantly with seizures, persistent headache, and vision changes, along with variable mental status alterations. PRES is likely to be reversible, particularly after withholding cyclosporine (CsA). Acute Toxic Leukoencephalopathy (ATL) presents with cognitive dysfunction, decreased levels of consciousness, and vision changes. Other Leukoencephalopathy (OLE) includes patients who behave similar to the ATL group, but with less prominent deep white matter changes on MRI. ATL and OLE are less likely to be reversible. The neurologic syndromes correlate with different MRI patterns. In PRES, subcortical and cortical involvement on MRI is associated with seizure, blurred vision, and dysarthria versus ATL and OLE, which involve deep white matter and cause mainly cognitive dysfunction. The different syndromes also carry different prognoses. All patients with Flu-associated encephalopathy had a median overall survival of only 169 days. Those with ATL had shorter overall survival (median 66 days) than patients with PRES (median 208 days). Potential risk factors for Flu-associated encephalopathy were older age, poor renal function, Flu dose, previously treated central nervous system (CNS) disease, or previous Flu-based transplant conditioning. Additional risk factors for PRES CNS Toxicity are CsA use and acute hypertension. Flu pharmacokinetic studies may be useful to reduce life-threatening Flu-associated risks of neuroToxicity.
Stefan Weidauer - One of the best experts on this subject based on the ideXlab platform.
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Toxic Leukoencephalopathy after heroin abuse without heroin vapor inhalation mr imaging and clinical features in three patients
Clinical Neuroradiology-klinische Neuroradiologie, 2010Co-Authors: Stella Blasel, Elke Hattingen, Michael Adelmann, Michael Nichtweis, Friedhelm E Zanella, Stefan WeidauerAbstract:Background and Purpose: Toxic Leukoencephalopathy has been associated with illicit heroin vapor inhalation. Despite the nonspecific and variable clinical presentation of these patients, they show typical radiologic findings. Previous studies evaluated typical radiologic findings with symmetric infratentorial hyperintense signal changes and similar alteration in the posterior limb of the internal capsule, the splenium of corpus callosum, the medial lemniscus and the lateral brainstem. In context with the reviewed literature, a series of another three cases with Toxic Leukoencephalopathy after heroin abuse other than vapor inhalation is presented.
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Toxic Leukoencephalopathy after heroin abuse without heroin vapor inhalation mr imaging and clinical features in three patients
Clinical Neuroradiology-klinische Neuroradiologie, 2010Co-Authors: Stella Blasel, Elke Hattingen, Michael Adelmann, Michael Nichtweis, Friedhelm E Zanella, Stefan WeidauerAbstract:Toxic Leukoencephalopathy has been associated with illicit heroin vapor inhalation. Despite the nonspecific and variable clinical presentation of these patients, they show typical radiologic findings. Previous studies evaluated typical radiologic findings with symmetric infratentorial hyperintense signal changes and similar alteration in the posterior limb of the internal capsule, the splenium of corpus callosum, the medial lemniscus and the lateral brainstem. In context with the reviewed literature, a series of another three cases with Toxic Leukoencephalopathy after heroin abuse other than vapor inhalation is presented. All three patients underwent magnet resonance imaging (MRI) including additional diffusion- weighted imaging and apparent diffusion coefficient maps. Clinical and laboratory findings were recorded. MRI of all three patients revealed similar symmetric supratentorial hyperintense signal changes involving the frontal, parietal, occipital and temporal lobes. The cortex was spared and the subcortical U fibers were partially involved. Further, the brainstem and the cerebellar white matter were not affected. Toxic Leukoencephalopathy without involvement of the cerebellum and brainstem is a rare complication of heroin abuse. The pattern of heroin-induced Toxic Leukoencephalopathy on MRI might not only be related to an unknown adulterant, but also to the mode of drug administration.
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Toxic Leukoencephalopathy after heroin abuse without heroin vapor inhalation mr imaging and clinical features in three patients original article
Klinische Neuroradiologie, 2010Co-Authors: Stella Blasel, Elke Hattingen, Michael Adelmann, Michael Nichtweis, Friedhelm E Zanella, Stefan WeidauerAbstract:Background and Purpose:Toxic Leukoencephalopathy has been associated with illicit heroin vapor inhalation. Despite the nonspecific and variable clinical presentation of these patients, they show typical radiologic findings. Previous studies evaluated typical radiologic findings with symmetric infratentorial hyperintense signal changes and similar alteration in the posterior limb of the internal capsule, the splenium of corpus callosum, the medial lemniscus and the lateral brainstem. In context with the reviewed literature, a series of another three cases with Toxic Leukoencephalopathy after heroin abuse other than vapor inhalation is presented.Patients and Methods:All three patients underwent magnet resonance imaging (MRI) including additional diffusion- weighted imaging and apparent diffusion coefficient maps. Clinical and laboratory findings were recorded.Results:MRI of all three patients revealed similar symmetric supratentorial hyperintense signal changes involving the frontal, parietal, occipital and temporal lobes. The cortex was spared and the subcortical U fibers were partially involved. Further, the brainstem and the cerebellar white matter were not affected.Conclusion:Toxic Leukoencephalopathy without involvement of the cerebellum and brainstem is a rare complication of heroin abuse. The pattern of heroin-induced Toxic Leukoencephalopathy on MRI might not only be related to an unknown adulterant, but also to the mode of drug administration.
Stella Blasel - One of the best experts on this subject based on the ideXlab platform.
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Toxic Leukoencephalopathy after heroin abuse without heroin vapor inhalation mr imaging and clinical features in three patients
Clinical Neuroradiology-klinische Neuroradiologie, 2010Co-Authors: Stella Blasel, Elke Hattingen, Michael Adelmann, Michael Nichtweis, Friedhelm E Zanella, Stefan WeidauerAbstract:Background and Purpose: Toxic Leukoencephalopathy has been associated with illicit heroin vapor inhalation. Despite the nonspecific and variable clinical presentation of these patients, they show typical radiologic findings. Previous studies evaluated typical radiologic findings with symmetric infratentorial hyperintense signal changes and similar alteration in the posterior limb of the internal capsule, the splenium of corpus callosum, the medial lemniscus and the lateral brainstem. In context with the reviewed literature, a series of another three cases with Toxic Leukoencephalopathy after heroin abuse other than vapor inhalation is presented.
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Toxic Leukoencephalopathy after heroin abuse without heroin vapor inhalation mr imaging and clinical features in three patients
Clinical Neuroradiology-klinische Neuroradiologie, 2010Co-Authors: Stella Blasel, Elke Hattingen, Michael Adelmann, Michael Nichtweis, Friedhelm E Zanella, Stefan WeidauerAbstract:Toxic Leukoencephalopathy has been associated with illicit heroin vapor inhalation. Despite the nonspecific and variable clinical presentation of these patients, they show typical radiologic findings. Previous studies evaluated typical radiologic findings with symmetric infratentorial hyperintense signal changes and similar alteration in the posterior limb of the internal capsule, the splenium of corpus callosum, the medial lemniscus and the lateral brainstem. In context with the reviewed literature, a series of another three cases with Toxic Leukoencephalopathy after heroin abuse other than vapor inhalation is presented. All three patients underwent magnet resonance imaging (MRI) including additional diffusion- weighted imaging and apparent diffusion coefficient maps. Clinical and laboratory findings were recorded. MRI of all three patients revealed similar symmetric supratentorial hyperintense signal changes involving the frontal, parietal, occipital and temporal lobes. The cortex was spared and the subcortical U fibers were partially involved. Further, the brainstem and the cerebellar white matter were not affected. Toxic Leukoencephalopathy without involvement of the cerebellum and brainstem is a rare complication of heroin abuse. The pattern of heroin-induced Toxic Leukoencephalopathy on MRI might not only be related to an unknown adulterant, but also to the mode of drug administration.
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Toxic Leukoencephalopathy after heroin abuse without heroin vapor inhalation mr imaging and clinical features in three patients original article
Klinische Neuroradiologie, 2010Co-Authors: Stella Blasel, Elke Hattingen, Michael Adelmann, Michael Nichtweis, Friedhelm E Zanella, Stefan WeidauerAbstract:Background and Purpose:Toxic Leukoencephalopathy has been associated with illicit heroin vapor inhalation. Despite the nonspecific and variable clinical presentation of these patients, they show typical radiologic findings. Previous studies evaluated typical radiologic findings with symmetric infratentorial hyperintense signal changes and similar alteration in the posterior limb of the internal capsule, the splenium of corpus callosum, the medial lemniscus and the lateral brainstem. In context with the reviewed literature, a series of another three cases with Toxic Leukoencephalopathy after heroin abuse other than vapor inhalation is presented.Patients and Methods:All three patients underwent magnet resonance imaging (MRI) including additional diffusion- weighted imaging and apparent diffusion coefficient maps. Clinical and laboratory findings were recorded.Results:MRI of all three patients revealed similar symmetric supratentorial hyperintense signal changes involving the frontal, parietal, occipital and temporal lobes. The cortex was spared and the subcortical U fibers were partially involved. Further, the brainstem and the cerebellar white matter were not affected.Conclusion:Toxic Leukoencephalopathy without involvement of the cerebellum and brainstem is a rare complication of heroin abuse. The pattern of heroin-induced Toxic Leukoencephalopathy on MRI might not only be related to an unknown adulterant, but also to the mode of drug administration.
Friedhelm E Zanella - One of the best experts on this subject based on the ideXlab platform.
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Toxic Leukoencephalopathy after heroin abuse without heroin vapor inhalation mr imaging and clinical features in three patients
Clinical Neuroradiology-klinische Neuroradiologie, 2010Co-Authors: Stella Blasel, Elke Hattingen, Michael Adelmann, Michael Nichtweis, Friedhelm E Zanella, Stefan WeidauerAbstract:Background and Purpose: Toxic Leukoencephalopathy has been associated with illicit heroin vapor inhalation. Despite the nonspecific and variable clinical presentation of these patients, they show typical radiologic findings. Previous studies evaluated typical radiologic findings with symmetric infratentorial hyperintense signal changes and similar alteration in the posterior limb of the internal capsule, the splenium of corpus callosum, the medial lemniscus and the lateral brainstem. In context with the reviewed literature, a series of another three cases with Toxic Leukoencephalopathy after heroin abuse other than vapor inhalation is presented.
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Toxic Leukoencephalopathy after heroin abuse without heroin vapor inhalation mr imaging and clinical features in three patients
Clinical Neuroradiology-klinische Neuroradiologie, 2010Co-Authors: Stella Blasel, Elke Hattingen, Michael Adelmann, Michael Nichtweis, Friedhelm E Zanella, Stefan WeidauerAbstract:Toxic Leukoencephalopathy has been associated with illicit heroin vapor inhalation. Despite the nonspecific and variable clinical presentation of these patients, they show typical radiologic findings. Previous studies evaluated typical radiologic findings with symmetric infratentorial hyperintense signal changes and similar alteration in the posterior limb of the internal capsule, the splenium of corpus callosum, the medial lemniscus and the lateral brainstem. In context with the reviewed literature, a series of another three cases with Toxic Leukoencephalopathy after heroin abuse other than vapor inhalation is presented. All three patients underwent magnet resonance imaging (MRI) including additional diffusion- weighted imaging and apparent diffusion coefficient maps. Clinical and laboratory findings were recorded. MRI of all three patients revealed similar symmetric supratentorial hyperintense signal changes involving the frontal, parietal, occipital and temporal lobes. The cortex was spared and the subcortical U fibers were partially involved. Further, the brainstem and the cerebellar white matter were not affected. Toxic Leukoencephalopathy without involvement of the cerebellum and brainstem is a rare complication of heroin abuse. The pattern of heroin-induced Toxic Leukoencephalopathy on MRI might not only be related to an unknown adulterant, but also to the mode of drug administration.
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Toxic Leukoencephalopathy after heroin abuse without heroin vapor inhalation mr imaging and clinical features in three patients original article
Klinische Neuroradiologie, 2010Co-Authors: Stella Blasel, Elke Hattingen, Michael Adelmann, Michael Nichtweis, Friedhelm E Zanella, Stefan WeidauerAbstract:Background and Purpose:Toxic Leukoencephalopathy has been associated with illicit heroin vapor inhalation. Despite the nonspecific and variable clinical presentation of these patients, they show typical radiologic findings. Previous studies evaluated typical radiologic findings with symmetric infratentorial hyperintense signal changes and similar alteration in the posterior limb of the internal capsule, the splenium of corpus callosum, the medial lemniscus and the lateral brainstem. In context with the reviewed literature, a series of another three cases with Toxic Leukoencephalopathy after heroin abuse other than vapor inhalation is presented.Patients and Methods:All three patients underwent magnet resonance imaging (MRI) including additional diffusion- weighted imaging and apparent diffusion coefficient maps. Clinical and laboratory findings were recorded.Results:MRI of all three patients revealed similar symmetric supratentorial hyperintense signal changes involving the frontal, parietal, occipital and temporal lobes. The cortex was spared and the subcortical U fibers were partially involved. Further, the brainstem and the cerebellar white matter were not affected.Conclusion:Toxic Leukoencephalopathy without involvement of the cerebellum and brainstem is a rare complication of heroin abuse. The pattern of heroin-induced Toxic Leukoencephalopathy on MRI might not only be related to an unknown adulterant, but also to the mode of drug administration.
Michael Nichtweis - One of the best experts on this subject based on the ideXlab platform.
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Toxic Leukoencephalopathy after heroin abuse without heroin vapor inhalation mr imaging and clinical features in three patients
Clinical Neuroradiology-klinische Neuroradiologie, 2010Co-Authors: Stella Blasel, Elke Hattingen, Michael Adelmann, Michael Nichtweis, Friedhelm E Zanella, Stefan WeidauerAbstract:Background and Purpose: Toxic Leukoencephalopathy has been associated with illicit heroin vapor inhalation. Despite the nonspecific and variable clinical presentation of these patients, they show typical radiologic findings. Previous studies evaluated typical radiologic findings with symmetric infratentorial hyperintense signal changes and similar alteration in the posterior limb of the internal capsule, the splenium of corpus callosum, the medial lemniscus and the lateral brainstem. In context with the reviewed literature, a series of another three cases with Toxic Leukoencephalopathy after heroin abuse other than vapor inhalation is presented.
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Toxic Leukoencephalopathy after heroin abuse without heroin vapor inhalation mr imaging and clinical features in three patients
Clinical Neuroradiology-klinische Neuroradiologie, 2010Co-Authors: Stella Blasel, Elke Hattingen, Michael Adelmann, Michael Nichtweis, Friedhelm E Zanella, Stefan WeidauerAbstract:Toxic Leukoencephalopathy has been associated with illicit heroin vapor inhalation. Despite the nonspecific and variable clinical presentation of these patients, they show typical radiologic findings. Previous studies evaluated typical radiologic findings with symmetric infratentorial hyperintense signal changes and similar alteration in the posterior limb of the internal capsule, the splenium of corpus callosum, the medial lemniscus and the lateral brainstem. In context with the reviewed literature, a series of another three cases with Toxic Leukoencephalopathy after heroin abuse other than vapor inhalation is presented. All three patients underwent magnet resonance imaging (MRI) including additional diffusion- weighted imaging and apparent diffusion coefficient maps. Clinical and laboratory findings were recorded. MRI of all three patients revealed similar symmetric supratentorial hyperintense signal changes involving the frontal, parietal, occipital and temporal lobes. The cortex was spared and the subcortical U fibers were partially involved. Further, the brainstem and the cerebellar white matter were not affected. Toxic Leukoencephalopathy without involvement of the cerebellum and brainstem is a rare complication of heroin abuse. The pattern of heroin-induced Toxic Leukoencephalopathy on MRI might not only be related to an unknown adulterant, but also to the mode of drug administration.
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Toxic Leukoencephalopathy after heroin abuse without heroin vapor inhalation mr imaging and clinical features in three patients original article
Klinische Neuroradiologie, 2010Co-Authors: Stella Blasel, Elke Hattingen, Michael Adelmann, Michael Nichtweis, Friedhelm E Zanella, Stefan WeidauerAbstract:Background and Purpose:Toxic Leukoencephalopathy has been associated with illicit heroin vapor inhalation. Despite the nonspecific and variable clinical presentation of these patients, they show typical radiologic findings. Previous studies evaluated typical radiologic findings with symmetric infratentorial hyperintense signal changes and similar alteration in the posterior limb of the internal capsule, the splenium of corpus callosum, the medial lemniscus and the lateral brainstem. In context with the reviewed literature, a series of another three cases with Toxic Leukoencephalopathy after heroin abuse other than vapor inhalation is presented.Patients and Methods:All three patients underwent magnet resonance imaging (MRI) including additional diffusion- weighted imaging and apparent diffusion coefficient maps. Clinical and laboratory findings were recorded.Results:MRI of all three patients revealed similar symmetric supratentorial hyperintense signal changes involving the frontal, parietal, occipital and temporal lobes. The cortex was spared and the subcortical U fibers were partially involved. Further, the brainstem and the cerebellar white matter were not affected.Conclusion:Toxic Leukoencephalopathy without involvement of the cerebellum and brainstem is a rare complication of heroin abuse. The pattern of heroin-induced Toxic Leukoencephalopathy on MRI might not only be related to an unknown adulterant, but also to the mode of drug administration.