Purpose: To describe non-metabolic, non-infectious etiologies of acute toxic leukoencephalopathy (ATL) on DWI MRI, and provide a useful acronym to remember them.
Material and methods: Our PACS archive was reviewed, yielding 185 patients with suspected ATL per MRI reports and clinical follow up; infectious or metabolic causes were excluded.
Result/discussion: The 87 included non-infectious, non-metabolic ATL patients' etiologies are represented by the acronym 'CHOICES': chemotherapy ('C',n = 34); heroin-induced ('H',n = 6), opioid analogues ('O',n = 14); immunosuppressant ('I',n = 11) or imidazole (n = 2); cocaine ('C',n = 1); environmental or ethanol abuse ('E',n = 5), splenial lesions ('S',n = 9), and 'other' (n = 5).
Conclusion: The "CHOICES" acronym delineates various toxic etiologies of ATL.
Keywords: ADEM, Acute disseminated encephalomyelitis; AEDs, Anti-epileptic drugs; AHE, Acute Hepatic/Hyperammonemic Encephalopathy; AHL, Acute hemorrhagic leukoencephalitis; ATL, Acute toxic leukoencephalopathy; Acute toxic leukoencephalopathy; CO, Carbon monoxide; Diffusion-Weighted imaging; EPM, Extrapontine myelinolysis; EtOH, Ethanol; HIE, Hypoxic-ischemic encephalopathy; LE, leukoencephalopathy; MBD, Marchiafava-Bignami Disease; MERS, Mild encephalitis/encephalopathy with reversible splenial lesion; NAWM, Normal-appearing white matter; ODS, Osmotic demyelination syndrome; PML, Progressive multifocal leukoencephalopathy; PRES, Posterior reversible encephalopathy syndrome; PVWM, Periventricular white matter; Periventricular white matter; RIS, Radiology information system; RSL, Reversible splenial lesions.