Journal of neuroimaging : official journal of the American Society of Neuroimaging · 2009
Clinical and MRI characteristics of levamisole-induced leukoencephalopathy in 16 patients.
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Xu Ning'an, Zhou Wenbin, Li Shuyu, Zhou Gaofeng, Zhang Ning, Liang Jinghui
Аннотация
OBJECTIVE: To study the clinical and radiological characteristics of levamisole-induced leukoencephalopathy (LILE) in patients with recurrent aphthous ulcers (RAU) or infected with Ascaris.
METHODS: The medical histories of 16 patients with LILE were analyzed, including clinical manifestations, brain magnetic resonance imaging (MRI) characteristics, cerebrospinal fluid, and brain biopsy findings.
RESULTS: The main clinical manifestations of LILE were motor weakness (75.0%), dysphasia or aphasia (50.0%), cognitive disorder (50.0%), and facial palsy (43.8%). The MRI of 16 cases showed plaque and round or oval demyelinating lesions in white matter, which revealed a signal hypointensity on T1-weighted and diffusion-weighted images (DWI), and demonstrated hyperintensity on T2-weighted and fluid-attenuated inversion recovery (FLAIR) images. The MRI revealed peripheral ring-type enhancement about the focus after Gd-DTPA administration and edema around some lesions, without mass effect. T2-weighted and FLAIR images were highly sensitive to the lesions. Brain biopsy in 1 patient showed multifocal demyelinating lesions without perivascular cuffing by lymphocytes. Treatment generally consisted of steroids and hyperbaric oxygen therapy, and patients recovered to normal condition.
CONCLUSIONS: A single normal dose of levamisole can induce leukoencephalopathy in patients with RAU or Ascaris. The diagnosis depends on the clinical features and imaging appearances. Steroid therapy might be a good choice of treatment.
METHODS: The medical histories of 16 patients with LILE were analyzed, including clinical manifestations, brain magnetic resonance imaging (MRI) characteristics, cerebrospinal fluid, and brain biopsy findings.
RESULTS: The main clinical manifestations of LILE were motor weakness (75.0%), dysphasia or aphasia (50.0%), cognitive disorder (50.0%), and facial palsy (43.8%). The MRI of 16 cases showed plaque and round or oval demyelinating lesions in white matter, which revealed a signal hypointensity on T1-weighted and diffusion-weighted images (DWI), and demonstrated hyperintensity on T2-weighted and fluid-attenuated inversion recovery (FLAIR) images. The MRI revealed peripheral ring-type enhancement about the focus after Gd-DTPA administration and edema around some lesions, without mass effect. T2-weighted and FLAIR images were highly sensitive to the lesions. Brain biopsy in 1 patient showed multifocal demyelinating lesions without perivascular cuffing by lymphocytes. Treatment generally consisted of steroids and hyperbaric oxygen therapy, and patients recovered to normal condition.
CONCLUSIONS: A single normal dose of levamisole can induce leukoencephalopathy in patients with RAU or Ascaris. The diagnosis depends on the clinical features and imaging appearances. Steroid therapy might be a good choice of treatment.