Imaging Patterns of Toxic and Metabolic Brain Disorders

Abstract

Toxic and metabolic brain disorders are relatively uncommon diseases that affect the central nervous system, but they are important to recognize as they can lead to catastrophic outcomes if not rapidly and properly managed. Imaging plays a key role in determining the most probable diagnosis, pointing to the next steps of investigation, and providing prognostic information. The majority of cases demonstrate bilateral and symmetric involvement of structures at imaging, affecting the deep gray nuclei, cortical gray matter, and/or periventricular white matter, and some cases show specific imaging manifestations. When an appropriate clinical situation suggests exogenous or endogenous toxic effects, the associated imaging pattern usually indicates a restricted group of diagnostic possibilities. Nonetheless, toxic and metabolic brain disorders in the literature are usually approached in the literature by starting with common causal agents and then reaching imaging abnormalities, frequently mixing many different possible manifestations. Conversely, this article proposes a systematic approach to address this group of diseases based on the most important imaging patterns encountered in clinical practice. Each pattern is suggestive of a most likely differential diagnosis, which more closely resembles real-world scenarios faced by radiologists. Basic pathophysiologic concepts regarding cerebral edemas and their relation to imaging are introduced-an important topic for overall understanding. The most important imaging patterns are presented, and the main differential diagnosis for each pattern is discussed.

Neuroimaging of Propofol Infusion Syndrome: A Case Report and Review of Literature

“…Overall, similar acute findings have been reported on brain imaging after hypoxic brain injury in the setting of carbon monoxide toxicity, including spatial distribution [13][14][15]. This is not unexpected since both carbon monoxide and propofol action are centered on the mitochondrial electron transport chain, with carbon monoxide targeting complex IV (unlike complex I inhibition by propofol) [16].…”

Chronic methanol toxicity through topical and inhalational routes presenting as vision loss and restricted diffusion of the optic nerves on MRI: A case report and literature review

“…As such, methanol toxicity is an important differential diagnosis in unexplained vision loss. On cranial MR imaging, the most characteristic imaging feature of methanol poisoning is bilateral symmetric basal ganglia necrosis [ [3] , [4] , [5] , [6] , [7] ] .…”

Unusual lesion in the splenium of the corpus callosum and coronavirus infectious disease-19

“…Thirdly, a massive release of inflammatory cytokines, can cause brain inflammation similar to secondary hemophagocytic lymphohistiocytosis (15). And last but not the least, the use of multiple drugs in the acute phase, the possible development of vitamin deficiencies, malnourishment, dehydration, high fever, metabolic alterations, prolonged immobility and cerebral hypoperfusion in the severely acute COVID-19 patients, may all contribute to a variety of peripheral nervous system, brain and spine alterations often also seen in other toxic and metabolic diseases (16,17).…”