Toxic and metabolic encephalopathies: iconographic essay

Generally, toxic-metabolic diseases affecting the central nervous system can hardly be differentiated just on the basis of their clinical presentation. However, some typical neuroradiological features can guide the correct diagnosis. In this context, magnetic resonance imaging is an important tool which, in association with clinical and laboratory data, can establish an early and specific treatment. The present pictorial essay with selected cases from the archives of the authors' institution describes imaging findings which might help in the etiologic diagnosis of toxic-metabolic diseases.

Magnetic resonance imaging; Intoxication; Encephalopathy; Metabolic diseases

Authorship

Eric Mendonça Bimbato

MD, Resident of Radiology and Imaging Diagnosis, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil.Universidade Estadual de CampinasBrazilCampinas, SP, BrazilMD, Resident of Radiology and Imaging Diagnosis, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil.

Amanda Gontijo Carvalho

Graduate Student of Medicine, School of Medical Sciences, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil.Universidade Estadual de CampinasBrazilCampinas, SP, BrazilGraduate Student of Medicine, School of Medical Sciences, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil.

Fabiano Reis Mailing Address: Dr. Fabiano Reis. FCM-Unicamp – Departamento de Radiologia. Rua Tessália Vieira de Camargo, 126, Cidade Universitária Zeferino Vaz. Caixa Postal: 6111. Campinas, SP, Brazil, 13083-887. E-mail: fabianoreis2@gmail.com.

PhD, Professor, Department of Radiology and Imaging Diagnosis, Professor Responsible for the Division of Neuroradiology, Department of Radiology and Imaging Diagnosis, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil.Universidade Estadual de CampinasBrazilCampinas, SP, BrazilPhD, Professor, Department of Radiology and Imaging Diagnosis, Professor Responsible for the Division of Neuroradiology, Department of Radiology and Imaging Diagnosis, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil.

Mailing Address: Dr. Fabiano Reis. FCM-Unicamp – Departamento de Radiologia. Rua Tessália Vieira de Camargo, 126, Cidade Universitária Zeferino Vaz. Caixa Postal: 6111. Campinas, SP, Brazil, 13083-887. E-mail: fabianoreis2@gmail.com.

SCIMAGO INSTITUTIONS RANKINGS

Figures

Figures (8)

Thumbnail

Figure 1
Wernicke syndrome. Female, 47-year-old patient. Coronal FLAIR (A) and axial T2-weighted (B,C) images show hypersignal foci in the periacqueductal gray substance, thalami in paramedian region, mammillary bodies (arrows), tectum and tegmentum of the mesencephalon. Contrast-enhanced T1-weighted image (D) demonstrates enhancement of mammillary bodies (arrows) and tectum of the mesencephalon.

Thumbnail

Figure 2
Hepatic encephalopathy by C virus. Female, 69-year-old. At non-contrast- enhanced T1-weighted image areas of hypersignal are visualized on the region of the globus pallidus, subthalami and base of the cerebral peduncles.

Thumbnail

Figure 3
Osmotic demyelination syndrome. Male, 49-year-old patient. At T2- weighted axial (A) and sagittal (B) images, area of hypersignal is observed on the pons, with preserved signal in the periphery.

Thumbnail

Figure 4
Methanol intoxication. Female, 25-year-old patient. Bilateral, symmetrical putaminal hypersignal on T2-weighted FLAIR image (A) diffusion restriction, hypersignal on diffusionweighted image (B) and hyposignal on ADC map (C). Hyperintense corticosubcortical lesions are observed in the occipital lobes with diffusion restriction. Proton spectroscopy with 135 ms TE shows lactate-related reversed peak around 1.3 ppm, besides decreased N-acetylaspartate (NAA) levels at 2.0 ppm.

Thumbnail

Figure 5
Wilson's disease. Female, 20-year-old patient. Lesions with hypersignal on FLAIR (A) in the tegmentum of the mesencephalon and periacqueductal and colliculi. Also, foci of hyposignal are observed on FAIR and T2-weighted images of the putamens and caudate nuclei heads.

Thumbnail

Figure 6
Ischemic stroke/arteritis with infarction caused by use of cocaine. Male, 21-year-old patient. Lesions are present in the putamen, caudate nuclei head and anterior leg of the internal capsule at right. Presence of area of hypersignal on T2-weighted FLAIR image, with a focus of putaminal hyposignal intensity (hemorrhage) (A,B). Diffusion-weighted image demonstrates hypersignal (C) and at the ADC map (D) there is hyposignal, except on the putaminal area of hemorrhagic transformation, with hyposignal on diffusion-weighted image and on the ADC map.

Thumbnail

Figure 7
Vitamin B12 deficiency. Sagittal, T2-weighted image (A) with posterior hypersignal on the spinal cord continuously extending along the whole cervical medulla and seen on T2-weighted image (B) in the posterior funicle (arrows).

Thumbnail

Figure 8
Patient with chronic renal failure undergoing prolonged dialysis treatment did not present hepatopathy. Axial T1-weighted image (A) identifying confluent foci of hypersignal in the globus pallidus at T1-weighted image. Axial FLAIR image(B) with hyposignal in the lenticular nucleus.

Figure 1 Wernicke syndrome. Female, 47-year-old patient. Coronal FLAIR (A) and axial T2-weighted (B,C) images show hypersignal foci in the periacqueductal gray substance, thalami in paramedian region, mammillary bodies (arrows), tectum and tegmentum of the mesencephalon. Contrast-enhanced T1-weighted image (D) demonstrates enhancement of mammillary bodies (arrows) and tectum of the mesencephalon.

Figure 2 Hepatic encephalopathy by C virus. Female, 69-year-old. At non-contrast- enhanced T1-weighted image areas of hypersignal are visualized on the region of the globus pallidus, subthalami and base of the cerebral peduncles.

Figure 3 Osmotic demyelination syndrome. Male, 49-year-old patient. At T2- weighted axial (A) and sagittal (B) images, area of hypersignal is observed on the pons, with preserved signal in the periphery.

Figure 4 Methanol intoxication. Female, 25-year-old patient. Bilateral, symmetrical putaminal hypersignal on T2-weighted FLAIR image (A) diffusion restriction, hypersignal on diffusionweighted image (B) and hyposignal on ADC map (C). Hyperintense corticosubcortical lesions are observed in the occipital lobes with diffusion restriction. Proton spectroscopy with 135 ms TE shows lactate-related reversed peak around 1.3 ppm, besides decreased N-acetylaspartate (NAA) levels at 2.0 ppm.

Figure 5 Wilson's disease. Female, 20-year-old patient. Lesions with hypersignal on FLAIR (A) in the tegmentum of the mesencephalon and periacqueductal and colliculi. Also, foci of hyposignal are observed on FAIR and T2-weighted images of the putamens and caudate nuclei heads.

Figure 6 Ischemic stroke/arteritis with infarction caused by use of cocaine. Male, 21-year-old patient. Lesions are present in the putamen, caudate nuclei head and anterior leg of the internal capsule at right. Presence of area of hypersignal on T2-weighted FLAIR image, with a focus of putaminal hyposignal intensity (hemorrhage) (A,B). Diffusion-weighted image demonstrates hypersignal (C) and at the ADC map (D) there is hyposignal, except on the putaminal area of hemorrhagic transformation, with hyposignal on diffusion-weighted image and on the ADC map.

Figure 7 Vitamin B12 deficiency. Sagittal, T2-weighted image (A) with posterior hypersignal on the spinal cord continuously extending along the whole cervical medulla and seen on T2-weighted image (B) in the posterior funicle (arrows).

Figure 8 Patient with chronic renal failure undergoing prolonged dialysis treatment did not present hepatopathy. Axial T1-weighted image (A) identifying confluent foci of hypersignal in the globus pallidus at T1-weighted image. Axial FLAIR image(B) with hyposignal in the lenticular nucleus.

How to cite

copy

Publicação do Colégio Brasileiro de Radiologia e Diagnóstico por Imagem Av. Paulista, 37 - 7º andar - conjunto 71, 01311-902 - São Paulo - SP, Tel.: +55 11 3372-4541, Fax: 3285-1690, Fax: +55 11 3285-1690 - São Paulo - SP - Brazil
E-mail: radiologiabrasileira@cbr.org.br

Acompanhe os números deste periódico no seu leitor de RSS

Versão para download de PDF

PDF

Inglês
Português

Versões e tradução automática

Versão original do texto

English
Português

Tradução automática

Google Translator
Microsoft Translator

Como citar

RIS

BIBTEX

Outros formatos de citação e exportação:

SciELO - Scientific Electronic Library Online
Rua Dr. Diogo de Faria, 1087 – 9º andar – Vila Clementino 04037-003 São Paulo/SP - Brasil
E-mail: scielo@scielo.org