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Table of Contents
IMAGES IN NEUROLOGY
Year : 2019  |  Volume : 22  |  Issue : 2  |  Page : 217-218
 

Boomerang in the brain


1 Department of Neurology, University College of Medical Sciences and GTB Hospital, New Delhi, India
2 Department of Medicine, All India Institute of Medical Sciences, New Delhi, India

Date of Web Publication9-Apr-2019

Correspondence Address:
Dr. Vaibhav Deorari
GH4/18 Meera Apartments, Paschim Vihar, New Delhi - 110 063
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aian.AIAN_447_18

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How to cite this article:
Singla P, Deorari V. Boomerang in the brain. Ann Indian Acad Neurol 2019;22:217-8

How to cite this URL:
Singla P, Deorari V. Boomerang in the brain. Ann Indian Acad Neurol [serial online] 2019 [cited 2019 Jun 18];22:217-8. Available from: http://www.annalsofian.org/text.asp?2019/22/2/217/255688




We are presenting a case who presented with slurring of speech, headache, and difficulty in maintaining balance for the past 8 h before presentation. The patient was working in paper printing workshop which involved used of printing dyes for the past 20 years and was working without any personal protective equipment. On examination, the patient had normal vitals but abnormal finger-nose test, the presence of dysdiadochokinesia, abnormal heel-knee test bilaterally, and ataxic gait but no nystagmus. Blood investigations of the patient were in normal range. Cerebrospinal fluid was normal microscopically and biochemically. Magnetic resonance imaging (MRI) brain was done, which showed bilateral symmetric T2 and fluid-attenuated inversion recovery hyperintensities involving the vestibular and dentate nuclei of the cerebellum [Figure 1] and corpus callosum. Area of hyperintensity involving the corpus callosum predominantly splenium, which showed restricted diffusion [Figure 2] with hypointense signal on Apparent Diffusion Coefficient (ADC) map, which appears as a “Boomerang” [Figure 3]. The patient's complaints improved during hospital stay, and cerebellar signs disappeared by the 10th day. The patient was discharged and was advised not to engage in occupation involving printing dyes. Repeat MRI brain done after 12 weeks was normal [Figure 4]. A diagnosis of toxic encephalopathy with acute reversible cerebellar ataxia was made.
Figure 1: Magnetic resonance imaging of the brain showing hyperintensities involving the vestibular (Right arrow) and dentate nuclei (Left arrow) of the cerebellum

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Figure 2: Diffusion-weighted magnetic resonance imaging of the brain showing restricted diffusion in the splenium (Arrow) of the corpus callosum

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Figure 3: Magnetic resonance imaging of the brain showing area of hyperintensity involving the corpus callosum predominantly splenium (Arrow) showed restricted diffusion which appears as a “Boomerang”

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Figure 4: Magnetic resonance images of the brain showing resolution of lesion following the removal of occupational exposure

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Boomerang sign is an uncommon radiological sign seen in the presence of transient splenial lesions of the corpus callosum. Our patient had long-term occupational exposure to printing dyes containing toxic solvents. Toxic encephalopathy can be mimicked by various medical conditions. This can lead to a diagnostic dilemma. In case of toxic encephalopathy, these finding usually disappear after removal of the offending agent like it happened in our case.[1] Various toxins have been known which has an affinity for the white matter; these agents cause toxic damage by various mechanisms. These agents range from environmental toxins to radiations to chemotherapy drugs to the drugs of abuse and even the occupational exposures where various solvents such as toluene are implicated in causing injury. Earlier in 1980, when they were first described the mostly diagnosed by clinical history, examination neuropathological methods but with the advent of the MRI discrete areas can be identified premortem.[2]

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Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Kumar Y, Drumsta D, Mangla M, Gupta N, Hooda K, Almast J, et al. Toxins in brain! Magnetic resonance (MR) imaging of toxic leukoencephalopathy – A pictorial essay. Pol J Radiol 2017;82:311-9.  Back to cited text no. 1
    
2.
Filley CM, McConnell BV, Anderson CA. The expanding prominence of toxic leukoencephalopathy. J Neuropsychiatry Clin Neurosci 2017;29:308-18.  Back to cited text no. 2
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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