Koksel reported the acronym "CHOICES" to help identify causes of acute toxic leukoencephalopathy. The differential diagnosis includes infectious and metabolic disorders affected the white matter of the brain. The authors are from the University of Minnesota and Hannepin Healthcare Medical Center in Minneaplis.

Leukoencephalopathy is a disorder of the cerebral white matter with damage to myelin.


MRI appearance: abnormal signal on FLAIR or T2-weighted images. The affected areas are bright on diffusion-weighted images relative to normal white matter.


(C) chemotherapy

(H) heroin

(O) opioid analogue abuse

(I) immunosuppression or imidazole (fluconazole, etc) medications

(C) crack cocaine

(E) environmental toxins (carbon monoxide) or ethanol

(S) reversible splenial lesions of the corpus callosum (multiple drugs including anti-epileptic drugs, chemotherapy, immunosuppressant)



Immunosuppressing agents include cyclosporine, tacrolimus and cyclosphosphamide.

To read more or access our algorithms and calculators, please log in or register.