Transcript Toxic Leukoencephalopathy

Toxic
Leukoencephalopathy
Christopher M. Filley, M.D.
B.K. Kleinschmidt-DeMasters, M.D.
Douglas K. Novins, M.D.
Spero M. Manson, Ph.D.
Departments of Neurology,
Psychiatry, and Pathology
University of Colorado School of
Medicine
Background
• Leukoencephalopathy is a
structural alteration of brain
white matter
• Toxic causes include drugs of
abuse, cranial irradiation,
therapeutic drugs, and
environmental toxins
• Affected individuals may
develop white matter dementia
Cranial Irradiation
• Radiation for brain tumors can reduce
the tumor size but also can produce
unwanted leukoencephalopathy
• The left MRI scan shows a malignant
brain tumor before radiation; after
radiation (right), the tumor is smaller
but the white matter is damaged
Other Toxins that Can
Damage Brain White
Matter
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Alcohol (ethanol)
Cocaine
Intravenous heroin
Hallucinogenic drugs
(psilocybin)
• Probably Ecstacy
• Even anticancer drugs doctors
use for treatment of the tumor
may have the unwanted (but
currently unpreventable) side
effect of leukoencephalopathy
Pathogenesis
• In toxic leukoencephalopathy, white
matter damage can result from
injury to any important part of the
white matter including myelin,
oligodendrocytes, axons, astrocytes,
or blood vessels
Toluene Abuse
• Toluene is an organic solvent
commonly used in many
household products, including
spray paint, and in industry
• Heavy “glue/paint/ or gasoline
sniffing”, a form of inhalant drug
abuse often used by American
Indian and urban youth, results in
leukoencephalopathy
Future Aim
• Study brain damage due to toluene
abuse in American Indian and
urban youth, in whom the
prevalence of this problem is high,
by performing detailed
neurological, neuropsychological,
& psychiatric evaluations, in
conjunction with advanced brain
imaging (MRI) techniques, to
clarify the impact of this toxin on
brain function
• This population has NEVER been
adequately studied, nor has the
impact of the problem been fully
appreciated
The American
Indian and
Alaska Native
Program:
Mission
To promote the health and
well-being of American
Indians and Alaska Natives,
of all ages, by pursuing
research, training, continuing
education, technical
assistance, and information
dissemination within a
biopsychosocial framework
that recognizes the unique
cultural contexts of this
special population.