A number of conditions need to be considered in the differential diagnosis of toxic leukoencephalopathy.

Features shared with toxic leukoencephalopathy:

(1) abnormalities confined to the periventricular white matter (PVWM)

(2) reduced diffusion on diffusion weight imaging, usually without contrast enhancement


Features that distinguish from toxic leukoencephalopathy:

(1) history

(2) clinical presentation

(3) different appearance in other MR sequences


Conditions in the differential diagnosis ("mimics") of toxic leukoencephalopathy:

(1) osmotic demyelination

(2) acute hepatic encephalopathy

(3) infectious encephalopathy or mild encephalitis/encephalopathy with reversible splenial lesion (MERS)

(4) hypoxic-ischemic encephalopathy

(5) acute disseminated encephalomyelitis (ADEM)

(6) progressive multifocal leukoencephalopathy (PML)


(8) acute necrotizing encephalopathy

(9) acute hemorrhagic leukoencephalitis

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