Pre- and posttreatment MR imaging findings in lead encephalopathy

Abstract

A 41-year-old man suspected of having lead poisoning was evaluated with MR imaging before and after British antilewisite therapy. The MR imaging findings showed bilateral symmetric involvement of the occipital lobe, affecting predominantly the gray-white matter junction and the subcortical white matter. A right cerebellar lesion was noted, with focal hyperintensities involving the gray-white matter. Similar lesions were seen in the temporal, parietal, and frontal regions. These lesions resolved after chelation therapy.

Fig 1.

Prechelation MR imaging. A–C, T1- and T2-weighted axial and FLAIR (respectively) coronal MR images show cortical gray matter and subcortical white matter lesion in the occipital lobe with edema and sulcal effacement. D, FLAIR sagittal image shows involvement of subcortical white matter in the frontal regions, parieto-occipital lobe, body of the corpus callosum, and cerebellum.

Fig 2.

Postchelation MR imaging. A and B, T2-weighted axial and FLAIR coronal images show near-total resolution. Few focal subcortical white matter lesions are still seen in the occipital lobe. C, FLAIR sagittal images show near-total resolution.