MRI in Chronic Toluene Abuse: Low Signal in the Cerebral Cortex on T2-weighted Images

MRI may be helpful in showing brain toxicity associated with chronic toluene inhalation. We report clinical and MRI findings over 3 years in a man with gradual neurologic decline secondary to toluene abuse. Cerebral atrophy most prominently involved the corpus callosum and cerebellar vermis. On T2-weighted images, loss of gray-white matter contrast, diffuse supratentorial white matter high-signal lesions, and low signal in the basal ganglia and midbrain were seen. In addition, MRI showed abnormal labor cortical low signal on T2-weighted images, most prominent in the primary motor and visual cortex. This cortical T2 shortening, not previously described in this condition, may reflect iron deposition.