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Case Reports
. 2024 Jun;34(2):503-506.
doi: 10.1007/s00062-023-01358-z. Epub 2023 Nov 14.

Toxic Leukoencephalopathy due to Suspected Levamisole-adulterated Cocaine

Rafael Willems  1 , Se-Jong You  2 , Friederike Vollmer  3 , Elke Hattingen  2 , Stefan Weidauer  2
Affiliations
Case Reports

Toxic Leukoencephalopathy due to Suspected Levamisole-adulterated Cocaine

Rafael Willems et al. Clin Neuroradiol. 2024 Jun.
No abstract available

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Conflict of interest statement

R. Willems, S.-J. You, F. Vollmer, E. Hattingen and S. Weidauer declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Sequential MR imaging in a 29-year-old woman suffering from severe toxic leukoencephalopathy. a, e, i Axial fluid attenuated inversion recovery (FLAIR); b, f, j and c, g, k axial diffusion weighted images (DWI; b = 1000 s/mm2) and corresponding apparent diffusion coefficient (ADC) maps; d, h, l axial T1 weighted images (WI) after administration of contrast agent. a–d Initial MR imaging 3 days after drug intake showing partially conflating bilateral hyperintense signal changes in the centrum semiovale (a) with severe restricted diffusion (b, c; ADC mean: 0.23 × 10−3 mm2/s, arrow; normal: 0.72 × 10−3 mm2/s); slight punctuate contrast enhancement (d, arrow). e–h Follow-up imaging on day 12 disclosed progressive hyperintense lesions (e, f), slight improvement of lowered ADC values (g; ADC mean: 0.37 × 10−3 mm2/s) and distinct patchy contrast enhancement (h, arrow). i–l On day 32 FLAIR images exhibit explicit bilateral hyperintense signal changes (i) with “shine through effect” on DWI (j), pseudonormalization of ADC values (k, arrow; range: 0.79–1.44 × 10−3 mm2/s) and decreasing contrast enhancement (l, arrow); note inhomogeneous lowering of T1 signal in the centrum semi-ovale (l, arrowhead)
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