Date of Award

9-27-2010

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Dr. Robert Fulbright

Abstract

The purpose of our study was to determine the incidence, causes, and reversibility of leukoencephalopathies demonstrating confluent areas of restricted diffusion on magnetic resonant imaging (DWI+LE). We hypothesized DWI+LE would have a low incidence, and be primarily caused by toxic exposures. We performed a logic sentence based search of the Yale-New Haven MRI database to select for reports indicating restricted diffusion within the cerebral white matter. We examined patients neuroimaging studies and medical record. We identified a total of 35 cases of DWI+LE, which resulted in an overall incidence of 0.2% over the five-year period queried. The medical conditions associated with DWI+LE were as follows: toxic exposure (7), hypoxia with concurrent trauma (7), hypoxia with concurrent toxic exposure (4), hypoxia with concurrent metabolic derangements (4), seizure with concurrent metabolic derangements (2), metabolic derangements (2), antiepileptic therapy (2), hypoxia (1), trauma (1), and unknown (5). The most favorable outcomes were seen in patients with intrathecal methotrexate toxicity, while patients with hypoxia without a lucid interval fared worst. We concluded that DWI+ LE are rare, their etiology diverse, and its reversibility dependant upon the type and severity of the insult.

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