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Table of Contents    
Year : 2021  |  Volume : 69  |  Issue : 5  |  Page : 1490-1491

Anaemia Induced Leukoencephalopathy: A Rare Case with Reversible Neuro-Radiological Features

1 Department of Neurology, St Stephen's Hospital, Delhi, India
2 Department of Neurology, Aster Malabar Institute of Medical Sciences, Calicut, Kerela, India

Date of Submission12-May-2020
Date of Decision13-Aug-2020
Date of Acceptance08-Oct-2020
Date of Web Publication30-Oct-2021

Correspondence Address:
Gaurav K Mittal
Department of Neurology, St Stephen's Hospital, Delhi - 110 054
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0028-3886.329598

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How to cite this article:
Kaur H, Mittal GK, Sureshbabu S, Singhdev J, Sekhar S. Anaemia Induced Leukoencephalopathy: A Rare Case with Reversible Neuro-Radiological Features. Neurol India 2021;69:1490-1

How to cite this URL:
Kaur H, Mittal GK, Sureshbabu S, Singhdev J, Sekhar S. Anaemia Induced Leukoencephalopathy: A Rare Case with Reversible Neuro-Radiological Features. Neurol India [serial online] 2021 [cited 2021 Dec 2];69:1490-1. Available from:

A 41-year-old female presented with menorrhagia, fatigue, dyspnea for six months and altered sensorium for the last three days. There was no other history of significance. She was severely pale, drowsy and confused. Hematological examination revealed very low hemoglobin (2.6 mg/dL), packed cell volume 8.8%, mean corpuscular volume 74.7 fL, red cell distribution width 28.5%. Serum iron levels were very low (10 μg/dL) and transferrin saturation was 2.66%. Rest of the detailed blood work-up was unremarkable. Magnetic resonance imaging (MRI) of brain revealed symmetrical hyperintensity in deep periventricular, subcortical white matter in bilateral frontotemporoparietal regions including centrum semiovale and corpus callosum on T2-weighted and FLAIR images with diffusion restriction [Figure 1]. Abdominal sonography revealed uterine fibroids. Following three units of packed cell transfusion and hematinics, there was a dramatic improvement in her sensorium and MRI (done after three weeks) [Figure 2].
Figure 1: (a) MRI diffusion-weighted sequence showing restricted diffusion (hyperintensity pointed by arrowhead), (b) apparent diffusion coefficient map showing corresponding hypointensity on, and (c) fluid attenuated inversion recovery sequence showing corresponding hyperintensity

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Figure 2: Complete reversal of earlier changes (a), (b) and (c) respectively

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Acute toxic leukoencephalopathy is a clinico-radiological syndrome characterized by structural alteration of myelin leading to diffuse white matter dysfunction.[1] The etiology of this uncommon disease can be cranial irradiation, environmental/metabolic toxins, therapeutic drugs, illicit drugs and uremia.[2],[3] To the best of our knowledge, this is the first case of anemia causing acute leukoencephalopathy.

The proposed pathophysiological mechanism can be anemic hypoxia related abnormalities of mitochondrial electron transport chain impairing adenosine triphosphate production resulting in leucotoxicity.

This is of potential clinical importance as lack of awareness may lead to misdiagnosis. Also, we wish to emphasize the prognostic importance of MRI in predicting the clinical outcome.


We wish to acknowledge the support of Dr Sumidha Mittal and Dr Sudhir Joseph, St Stephen's Hospital, Delhi, India.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Holyoak AL, Trout MJ, White RP, Prematuranga S, Senthuran S. Toxic leukoencephalopathy in the intensive care unit. Anaesth Intensive Care 2014;42:782-8.  Back to cited text no. 1
Filley CM, Kleinschmidt-DeMasters BK. Toxic leukoencephalopathy. N Engl J Med 2001;345:425-32.  Back to cited text no. 2
Kang E, Jeon SJ, Choi S-S. Uremic encephalopathy with atypical magnetic resonance features on diffusion-weighted images. Korean J Radiol 2012;13:808-11.  Back to cited text no. 3


  [Figure 1], [Figure 2]


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