The MR imaging findings of heroin-induced toxic leukoencephalopathy in our patient are lesser known, with predominant involvement of the frontoparietal lobes rather than the posterior limb internal capsules
, occipital lobes, cerebellum or brainstem.
In this patient, a lacunar infarct of the right internal capsule
induced severe symptoms, but a similar finding has not been reported.
No change was found in the fractional anisotropy of the right anterior limb of internal capsule
or in the apparent diffusion coefficient of the bilateral anterior limb of the internal capsule
The nucleus accumbens, internal capsule
, und cg25 all appear to be connected to the medial forebrain bundle.
Lacunae are located in the thalamus, basal ganglia, internal capsule
and brainstem (central pons).
The same disposition could be seen in the case of the anterior white commissure, the striatum, the internal capsule
and the tail of the caudate nucleus (Fig.
In the posterior internal capsules
, a significant negative correlation was found with white matter volume (Tmax Right = 5.
Repeat CT scan of the brain showed new bilateral temporo-occipital hypodensity more on the left side and a probable right middle cerebellar and left thalamic internal capsule
For example, a stroke in the internal capsule
might interrupt sensory fibers, motor fibers, and fibers involved in other functions, all running very close to one another.
The corticospinal tracts descend from the motor cortex and pass through the internal capsule
, crus, and eventually through the brainstem with the corticobulbar tracts.
A computed tomographic scan revealed posterior fossa atrophy, multiple basal ganglia and internal capsule
infarcts, mild fourth ventricle enlargement, and periventricular white matter changes.
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