Disseminated Necrotizing Leukoencephalopathy (DNL)

Synonyms:

a.k.a. Multifocal necrotizing leukoencephalopathy

Diagnosis:

Clinical +MRI +/-biopsy
Occurs after Radiation therapy and/or chemotherapy

Clinical features:

Encephalopathy
Occurs after Radiation therapy and/or chemotherapy

Findings on Investigations:

CT:

  • White matter, Periventricular, centrum semiovale. Spares the U fibres
  • Hypodensity in white matter. Enhancement can occur.

MRI:

  • White matter, Periventricular, centrum semiovale. Spares the U fibres
  • T2 hyperintensity. Enhancement can occur.

Pathology:

Necrosis, reactive gliosis, axonal swelling, demyelination,
White matter necrosis, necrosis & loss of myelin & axons which may calcify, lipid-laden macrophages.
Due to:

  • Radiation therapy and/or chemotherapy
  • Septic shock
  • Other insults

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