Korean J Radiol.  2016 Apr;17(2):277-280. 10.3348/kjr.2016.17.2.277.

Chlorfenapyr-Induced Toxic Leukoencephalopathy with Radiologic Reversibility: A Case Report and Literature Review

Affiliations
  • 1Department of Radiology, Chonnam National University Hospital, Gwangju 61469, Korea.
  • 2Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun 58128, Korea. kimsk.rad@gmail.com

Abstract

Chlorfenapyr is a widely used, moderately hazardous pesticide. Previous reports have indicated that chlorfenapyr intoxication can be fatal in humans. We reported the first non-fatal case of chlorfenapyr-induced toxic leukoencephalopathy in a 44-year-old female with resolution of extensive and abnormal signal intensities in white matter tracts throughout the brain, brain stem, and spinal cord on serial magnetic resonance imaging.

Keyword

Chlorfenapyr; Reversible toxic leukoencephalopathy; Diffusion-weighted image

MeSH Terms

Adult
Brain/*radiography
Brain Stem/radiography
Female
Humans
Insecticides/*toxicity
Leukoencephalopathies/*etiology/radiography
*Magnetic Resonance Imaging
Pyrethrins/*toxicity
Spinal Cord/*radiography
White Matter/radiography
Insecticides
Pyrethrins

Figure

  • Fig. 1 Chlorfenapyr-induced toxic leukoencephalopathy in 44-year-old female patient. A. Axial T2-weighted images show diffuse, bilaterally-symmetrical, and increased signal intensities involving periventricular white matter, corpus callosum, internal capsule, cerebellar white matter, and pons (corticospinal tract and central tegmental tract). B. Lesions show significant diffusion restriction on axial diffusion-weighted images and apparent diffusion coefficient map. C. Sagittal T2-weighted spinal images show diffuse enlargement of whole spinal cord with increased signal intensity. D. Follow-up axial T2-weighted images at 71 days after initial presentation show complete improvement in abnormal signal intensity within white matter throughout brain. E. Follow-up diffusion-weighted images confirmed complete resolution of previously noted restricted diffusion. F. Follow-up sagittal T2-weighted image of cervicothoracic spine shows improved general enlargement and hyperintensity of cervical and upper thoracic spinal cord. However, sagittal T2-weighted image of thoracolumbar spine shows residual hyperintensity in spinal cord below T7, with atrophic change.


Reference

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