Advertisement

Der Radiologe

, Volume 58, Issue 12, pp 1067–1079 | Cite as

Toxische Veränderungen des zentralen Nervensystems

  • W. Reith
  • A. Haußmann
Leitthema
  • 62 Downloads

Zusammenfassung

Klinisches Problem

Verschiedene Toxine können Veränderungen im Marklager, sog. Leukenzephalopathien hervorrufen. Diese Veränderungen manifestieren sich als Signalanomalien der weißen Substanz mit oder ohne eingeschränkte Diffusion. Sie sind oft reversibel, können aber auch zu irreversiblen Veränderungen führen. Die möglichen Differenzialdiagnosen bei toxischen Leukenzephalopathien sind umfassend.

Empfehlung für die Praxis

Für den Radiologen ist es essenziell, sich mit den Ursachen, der klinischen Präsentation und insbesondere den bildgebenden Befunden der toxischen Leukenzephalopathie vertraut zu machen, da eine frühzeitige Behandlung oft zu einer verbesserten Prognose führt.

Schlüsselwörter

Toxische Substanzen Weiße Substanz Leukenzephalopathie Magnetresonanztomographie Differenzialdiagnosen 

Toxic changes of the central nervous system

Abstract

Clinical issues

Various toxic agents can cause changes to the white matter of the brain leading to leukoencephalopathies. These changes often lead to signal alterations of the white matter with or without a diffusion restriction signal. White matter lesions can be reversible or irreversible. There are many differential diagnoses of toxic leukoencephalopathies.

Practical recommendations

For the radiologist it is necessary to be familiar with the causes, the clinical and the imaging presentation of toxic leukoencephalopathies because early treatment often leads to improved prognosis.

Keywords

Toxic agents White matter Leukoencephalopathy Magnetic resonance imaging Differential diagnosis 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

W. Reith und A. Haußmann geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Literatur

  1. 1.
    Filley CM, Kleinschmidt-demasters BK (2001) Toxic leukoencephalopathy. N Engl J Med 345(6):425–432CrossRefGoogle Scholar
  2. 2.
    Kumar Y et al (2017) Toxins in brain! Magnetic Resonance (MR) imaging of toxic leukoencephalopathy – a pictorial essay. Pol J Radiol 82:311–319CrossRefGoogle Scholar
  3. 3.
    Mckinney AM, Kieffer SA, Paylor RT et al (2009) Acute toxic leukoencephalopathy: potential for reversibility clinically and on MRI with diffusion-weighted and FLAIR imaging. AJR Am J Roentgenol 193(1):192–206CrossRefGoogle Scholar
  4. 4.
    Vázquez E, Delgado I, Sánchez-Montañez A et al (2011) Side effects of oncologic therapies in the pediatric central nervous system: update on neuroimaging findings. Radiographics 31:1123–1139CrossRefGoogle Scholar
  5. 5.
    Barcovich J, Raybaud C (2012) Metabolic, toxic and inflammatory brain disorders. In: Mitchel CW (Hrsg) Pediatric neuroimaging, 5. Aufl. Lippincott Williams & Wilkins, Philadelphia, S 117–118Google Scholar
  6. 6.
    Valk PE, Dillon WPL (1991) Radiation injury of the brain. AJNR Am J Neuroradiol 12(1):45–62Google Scholar
  7. 7.
    Kang E, Jeon SJ, Choi S (2012) Uremic encephalopathy with atypical magnetic resonance f eatures on diffusion-weighted images. Korean J Radiol 13(6):808–811CrossRefGoogle Scholar
  8. 8.
    Lo CP, Chen SY, Lee KW et al (2007) Brain injury after acute carbon monoxide poisoning: early and late complications. AJR Am J Roentgenol 189(4):W205–11CrossRefGoogle Scholar
  9. 9.
    Grossmann RI, Yousem DM (2003) Neuroradiology: the requisites, 2. Aufl. Mosby, St. LouisGoogle Scholar
  10. 10.
    Fischer M, Schmutzhardt E (2016) Das posteriore reversible Enzephalopathiesyndrom. Med Klin Intensivmed Notfmed 111:417CrossRefGoogle Scholar
  11. 11.
    Fugate JE, Rabinstein AA (2015) Posterior reversible encephalopathy syndrome: clinical and radiological manifestations, pathophysiology, and outstanding questions. Lancet Neurol 14:914–925CrossRefGoogle Scholar
  12. 12.
    Kastrup O, Schlamann M, Moenninghoff C et al (2015) Posterior reversible encephalopathy syndrome: the spectrum of MR imaging patterns. Clin Neuroradiol 25:161–171CrossRefGoogle Scholar
  13. 13.
    Thurnher MM, Thurnher SA, Schindler E (1997) CNS involvement in AIDS: spectrum of CT and MR findings. Eur Radiol 7:1091–1097CrossRefGoogle Scholar
  14. 14.
    Shah SS, Zimmerman RA, Rorke LB, Vezina LG (1996) Cerebrovascular complications of HIV in children. AJNR Am J Neuroradiol 17:1913–1917Google Scholar
  15. 15.
    O’Charoen P, Hesselink JR, Healy JF (2007) Cerebral aneurysmal arteriopathy in an adult patient with acquired immunodeficiency syndrome. AJNR Am J Neuroradiol 28:938–939Google Scholar
  16. 16.
    Takeuchi M, Nobukuni K, Takata H et al (2005) Rapidly progressed acquired immunodeficiency syndrome dementia complex as an initial manifestation. Intern Med 44:757–760CrossRefGoogle Scholar
  17. 17.
    Offiah CE, Turnbull IW (2006) The imaging appearances of intracranial CNS infections in adult HIV and AIDS patients. Clin Radiol 61:393–340CrossRefGoogle Scholar
  18. 18.
    Smith AB, Smirniotopoulos JG, Rushing EJ (2008) Central nervous system infections associated with human immunodeficiency virus infection: radiologic-pathologic correlation. Radiographics 28(7):2033–2058CrossRefGoogle Scholar
  19. 19.
    Post MJ, Yiannoutsos C, Simpson D et al (1999) Progressive multifocal leukoencephalopathy in AIDS: are there any MR findings useful to patient management and predictive of patient survival? AIDS Clinical Trials Group, 243 Team. AJNR Am J Neuroradiol 20:1896–1906Google Scholar
  20. 20.
    Berger JR, Levy RM, Flomenhoft D, Dobbs M (1998) Predictive factors for prolonged survival in acquired immunodeficiency syndrome-associated progressive multifocal leukoencephalopathy. Ann Neurol 44:341–349CrossRefGoogle Scholar
  21. 21.
    Roullet E (1999) Opportunistic infections of the central nervous system during HIV-1 infection (emphasis on cytomegalovirus disease). J Neurol 246:237–243CrossRefGoogle Scholar
  22. 22.
    Auer DP, Pütz B, Gössl C et al (2001) Differential lesion patterns in CADASIL and sporadic subcortical arteriosclerotic encephalopathy: MR imaging study with statistical parametric group comparison. Radiology 218(2):443–451CrossRefGoogle Scholar
  23. 23.
    Stojanov D, Aracki-Trenkic A, Vojinovic S, Ljubisavljevic S, Benedeto-Stojanov D, Tasic A, Vujnovic S. Imaging characteristics of cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL). Bosn J Basic Med Sci.  https://doi.org/10.17305/bjbms.2015.247
  24. 24.
    Nevin S (1938) Gliomatosis cerebri. Brain 61:170–191CrossRefGoogle Scholar
  25. 25.
    Louis DN, Ohgaki H, Wiestler OD, Cavenee WK (2000) WHO classification of tumors, pathology and genetics of tumors of the nervous system. International Agency for Research on Cancer, LyonGoogle Scholar
  26. 26.
    Fallentin E, Skriver E, Herning M, Broholm H (2997) Gliomatosis cerebrian approbiate diagnosis? Case reports. Acta Radiol 38:381–390Google Scholar
  27. 27.
    Kattar MM, Kupisky WJ, Shimoyama RK (1997) Clonal analysis of gliomas. Hum Pathol 28:1166–1179CrossRefGoogle Scholar
  28. 28.
    Mendes A, Sampaio L (2016) Brain magnetic resonance in status epilepticus: a focused review. Seizure 38:63–67CrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Klinik für Diagnostische und Interventionelle NeuroradiologieUniversitätsklinikum des SaarlandesHomburg/SaarDeutschland

Personalised recommendations