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T2\u2010weighted MRI demonstrated multifocal high\u2010signal areas in the bilateral cerebral white matter, especially in the right frontal lobe. Neuropathologically, multifocal hydropic axonal swelling with a poor glial reaction was recognized diffusely in the bilateral deep cerebral white matter, being especially marked in the frontal lobe. The cortex, subcortical U\u2010fibers, corpus callosum, and anterior commissure were spared. The cerebellar white matter also showed similar changes, albeit less marked, but the brainstem was spared. Microscopically, the myeloma involvement of the CNS was limited to the dura, and the cerebral arteries showed slight atherosclerosis, but neither thrombi nor angitis. This case, although ultimately fatal, neurologically and neuroradiologically resembled reversible posterior leukoencephalopathy syndrome (RPLS) induced by IVIg and\/or G\u2010CSF, and the nature and selective distribution of the neuropathological changes suggested that the pathogenesis involved vasospasm of the bilateral internal carotid artery and the main trunks of the cerebral arteries, due to unknown cause, inducing ischemia in the deep white matter, which is supplied by long nutrient arteries.<\/jats:p>","DOI":"10.1111\/j.1440-1789.2007.00771.x","type":"journal-article","created":{"date-parts":[[2007,7,19]],"date-time":"2007-07-19T17:12:11Z","timestamp":1184865131000},"page":"364-370","source":"Crossref","is-referenced-by-count":11,"title":["An autopsy case of drug\u2010induced diffuse cerebral axonopathic leukoencephalopathy: The pathogenesis in relation to reversible posterior leukoencephalopathy 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